A longitudinal study of unilateral Ménière's disease and clinical evolutionary models.

OBJECTIVE: The heterogeneity of Ménière's disease is presently defined by a variety of subtypes. This study introduced three different subtypes of unilateral Ménière's disease based on the evolution of vertigo crises from their inception. METHOD: A longitudinal descriptive study of 327 unilateral Ménière's disease patients was performed. In a subgroup of patients followed from the onset of the disease, 3 subtypes of unilateral Ménière's disease were defined according to the vertiginous crises suffered during the first 10 years of the disorder. RESULTS: Data was available for 87 patients with unilateral Ménière's disease from the start of their disease (26.6 per cent of the original sample). These patients were grouped into three models according to their symptomatic evolution. Model 3 was associated with a worse hearing prognosis, a greater number of Tumarkin's otolithic crises and the need for surgery. Model 1 presented less hearing loss. CONCLUSION: Unilateral Ménière's disease models based on the evolution of vertiginous crises present differences according to aspects such as hearing loss, vertiginous crisis, Tumarkin's otolithic crisis and the need for surgery.

Infección grave por SARS-CoV-2: valoración clínica y evaluación funcional biomecánica al mes del alta hospitalaria / Severe SARS-CoV-2 infection: Clinical assessment and biomechanical functional evaluation one month after hospital discharge

Objetivo: Describir mediante un estudio transversal observacional la situación clínica y funcional, al mes del alta hospitalaria, de los pacientes ingresados con COVID-19 en la UCI del hospital entre marzo y diciembre del 2020. Material y métodos: Se estudiaron 59 pacientes mediante distintas escalas clínicas y pruebas de análisis biomecánico (dinamometría de mano, valoración del riesgo de caídas, análisis de la marcha y del equilibrio). Resultados: Al mes del alta los pacientes referían sintomatología persistente: disnea (47,5%) artromialgias (45%) y tos (22%). En el cuestionario EQ-5D-5L hasta el 73% de los pacientes refirieron niveles de ansiedad o depresión. El 74,6 y el 69,5% presentaban alteración en la fuerza de la mano derecha e izquierda, respectivamente. En el 38% de los pacientes el riesgo de caídas fue de moderado a muy alto. El índice somatosensorial se mantuvo en parámetros normales, mientras que los índices vestibular y, en menor medida, el visual se mostraron alterados. En la marcha, en el 81,4% de pacientes no se objetivaron alteraciones fuera de la normalidad, con una velocidad de marcha media normal. Conclusiones: A corto plazo, tras una infección grave por COVID-19 los pacientes presentan sintomatología persistente, ansiedad/depresión, deterioro del equilibrio con aumento del riesgo de caídas y pérdida de fuerza de empuñamiento en ambas manos.(AU)

Objective: To describe by an observational cross-sectional study the clinical and functional situation, at one month after hospital discharge, of patients admitted with COVID-19 in the hospital ICU between March and December 2020. Material and methods: 59 patients were studied using different clinical scales and biomechanical analysis tests (hand dynamometry, fall risk assessment, gait and balance analysis). Results: At one month after discharge, patients reported persistent symptoms: dyspnea (47.5%), arthromyalgia (45%) and cough (22%). In the EQ-5D-5L questionnaire up to 73% of patients reported levels of anxiety or depression. 74.6% and 69.5% presented alterations in the strength of the right and left hand, respectively. The risk of falls in 38% of patients was moderate to very high. The somatosensory index remained within normal parameters, while the vestibular and, to a lesser extent, the visual indexes were altered. In gait, 81.4% of patients showed no abnormalities outside the normal range, with a normal average walking speed. Conclusions: In the short term after severe COVID-19, patients have persistent symptomatology, anxiety/depression, impaired balance with increased risk of falls and loss of grip strength in both hands.(AU)

[Severe SARS-CoV-2 infection: Clinical assessment and biomechanical functional evaluation one month after hospital discharge]. / Infección grave por SARS-CoV-2: valoración clínica y evaluación funcional biomecánica al mes del alta hospitalaria.

OBJECTIVE: To describe by an observational cross-sectional study the clinical and functional situation, at one month after hospital discharge, of patients admitted with COVID-19 in the hospital ICU between March and December 2020. MATERIAL AND METHODS: 59 patients were studied using different clinical scales and biomechanical analysis tests (hand dynamometry, fall risk assessment, gait and balance analysis). RESULTS: At one month after discharge, patients reported persistent symptoms: dyspnea (47.5%), arthromyalgia (45%) and cough (22%). In the EQ-5D-5L questionnaire up to 73% of patients reported levels of anxiety or depression. 74.6% and 69.5% presented alterations in the strength of the right and left hand, respectively. The risk of falls in 38% of patients was moderate to very high. The somatosensory index remained within normal parameters, while the vestibular and, to a lesser extent, the visual indexes were altered. In gait, 81.4% of patients showed no abnormalities outside the normal range, with a normal average walking speed. CONCLUSIONS: In the short term after severe COVID-19, patients have persistent symptomatology, anxiety/depression, impaired balance with increased risk of falls and loss of grip strength in both hands.

Association between antibiotic pressure and the risk of colonization/infection by multidrug-resistant Acinetobacter baumannii complex: a time series analysis.

OBJECTIVE: To analyze the association between antibiotic pressure and the risk of colonization/infection by Acinetobacter baumannii complex (AB), evaluating both the individual and general prescriptions of antibiotics. METHODS: This is an analytical, observational, case-control study on patients admitted to an Intensive Care Unit (ICU) during an AB outbreak (14 months). A five-year time series was constructed with the monthly incidence of cases of infection/colonization with strains of AB resistant to each antibiotic administered and with the monthly consumption of these antibiotics in the ICU. RESULTS: We identified 40 patients either infected (23) or colonized (17) by AB and 73 controls. We found an epidemic multidrug-resistant clone of AB in 75% of cases. Risk factors associated with the development of AB infection/colonization were: greater use of medical instruments, the presence of a tracheostomy, cutaneous ulcers, surgical lesions and prior antibiotic therapies. The regression analysis of individual use of antibiotics showed that prior treatment with ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, levofloxacin, linezolid, and vancomycin was a risk factor for acquiring AB. ARIMA models showed that the relationship were greatest and statistically significant when the treatment occurred between 6 months (ceftazidime) and 9 months (imipenem and levofloxacin) prior. CONCLUSIONS: The dynamic and aggregate relationship between the incidence of infection/colonization by multidrug-resistant strains of AB and prior antibiotic treatment was statistically significant for intervals of 6 to 9 months.

Alteraciones posturográficas y oculomotoras en las primeras 24 horas tras un latigazo cervical / Posturographic and oculomotor findings in the first 24 hours after whiplash

Introducción y objetivos La sensación de inestabilidad es un síntoma frecuente tras un latigazo cervical (LC), existiendo alteraciones objetivas del control postural en fases crónicas. El objetivo fundamental de nuestro estudio fue evaluar las alteraciones objetivas del control postural, así como la presencia o ausencia de alteraciones oculomotoras en las fases agudas tras un LC. Material y métodos Se realizó un estudio posturográfico mediante sistema NedSVE/IBV y una valoración oculomotora en una muestra de 44 sujetos afectos de LC en las primeras 24h tras el accidente. Resultados Más de la mitad de los pacientes estudiados presentaron una valoración global por debajo de la normalidad. El patrón sensorial predominante fue el denominado patrón vestibular. Los parámetros fundamentales del test de Romberg (desplazamiento total, área de barrido, velocidad media, desplazamientos anteroposterior y mediolateral y fuerza anteroposterior) aumentaron siguiendo la secuencia Romberg ojos abiertos, Romberg gomaespuma ojos abiertos, Romberg ojos cerrados y Romberg gomaespuma ojos cerrados. En cuanto a la comparación con la normalidad y utilizando los valores de referencia del Instituto de Biomecánica de Valencia, los datos de los pacientes de LC muestran diferencias significativas en todos los parámetros analizados, salvo en la valoración de la marcha y el control rítmico direccional mediolateral. Conclusiones Nuestros datos confirman que los pacientes en fase aguda del LC presentan un peor control postural desde las primeras horas tras el accidente. Los resultados evidencian que los pacientes con LC tienen una mayor dependencia visual. Solo una minoría de los pacientes presentan alteraciones oculomotoras durante la exploración temprana (AU)

Introduction and objectives Instability is a frequent symptom after whiplash (WL) with alterations in postural control in chronic phases. The main objective of our study was to evaluate if there were objective alterations in postural control in the acute phases after a WL, as well as to determine the presence or absence of oculomotor alterations in early phases. Material and methods A posturographic study was carried out using the NedSVE/IBV system, as well as an oculomotor assessment, in a sample of 44 patients with WL in the first 24h after the accident. Results More than half of the patients had a global assessment below normal. The predominant sensory pattern was vestibular. The main parameters of the Romberg test (total displacement, swept area, average speed, anteroposterior and mediolateral displacement and anteroposterior force) increased following the sequence Romberg open eyes, Romberg foam rubber open eyes, Romberg closed eyes, and Romberg foam rubber closed eyes. Concerning the comparison with normality and using the reference values of the Institute of Biomechanics of Valencia, the data from the WL patients showed significant differences in all the parameters analysed, except for gait assessment and the mediolateral directional rhythmic control. Conclusions Our data confirm that patients in the acute phase of WL have worse postural control than non-injured persons. The results suggest that patients with WL have greater visual dependence. Only a minority of patients had oculomotor abnormalities during early examination (AU)

[Posturographic and oculomotor findings in the first 24 hours after whiplash]. / Alteraciones posturográficas y oculomotoras en las primeras 24 horas tras un latigazo cervical.

INTRODUCTION AND OBJECTIVES: Instability is a frequent symptom after whiplash (WL) with alterations in postural control in chronic phases. The main objective of our study was to evaluate if there were objective alterations in postural control in the acute phases after a WL, as well as to determine the presence or absence of oculomotor alterations in early phases. MATERIAL AND METHODS: A posturographic study was carried out using the NedSVE/IBV system, as well as an oculomotor assessment, in a sample of 44 patients with WL in the first 24h after the accident. RESULTS: More than half of the patients had a global assessment below normal. The predominant sensory pattern was vestibular. The main parameters of the Romberg test (total displacement, swept area, average speed, anteroposterior and mediolateral displacement and anteroposterior force) increased following the sequence Romberg open eyes, Romberg foam rubber open eyes, Romberg closed eyes, and Romberg foam rubber closed eyes. Concerning the comparison with normality and using the reference values of the Institute of Biomechanics of Valencia, the data from the WL patients showed significant differences in all the parameters analysed, except for gait assessment and the mediolateral directional rhythmic control. CONCLUSIONS: Our data confirm that patients in the acute phase of WL have worse postural control than non-injured persons. The results suggest that patients with WL have greater visual dependence. Only a minority of patients had oculomotor abnormalities during early examination.

[Comparison between extracorporeal shockwave therapy and radial pressure wave therapy in plantar fasciitis]. / Comparación de la terapia de ondas de choque extracorpóreas focales y presión radiales en la fascitis plantar.

OBJECTIVE: Plantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy. PATIENTS AND METHODS: Seventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the Roles & Maudsley Scale. RESULTS: At inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2groups. No adverse effects or complications were observed. CONCLUSIONS: Both extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis.

[Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management]. / Percepción del entorno de práctica enfermera de Atención Primaria de la Comunidad Valenciana, en departamentos con gestión pública y privada.

BACKGROUND: Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). METHOD: Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. RESULTS: Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. CONCLUSIONS: The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained.

Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period.

Vaccination has reduced rotavirus hospitalizations by 25% in European regions with low-moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003-2005)- and post-vaccine (2007-2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007-2009 (ß-coefficient = -0·43, 95% confidence intervals (95% CI) -0·68 to -0·17; and odds ratio 0·62, 95% CI 0·50-0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI -365 to -123); the decrease in DRG group III was €2269 per patient (95% CI -4098 to -380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.

A multifactorial regression analysis of the features of community-acquired rotavirus requiring hospitalization in Spain as represented in the Minimum Basic Data Set.

Over 10% of acute rotavirus gastroenteritis (ARGE) requires hospitalization because of complications. The aggravating factors have been widely analysed, but in an isolated way. We aimed to explore the interrelationship between the clinical and epidemiological factors that characterize rotavirus hospitalizations in Spain using information from the Minimum Basic Data Set (MBDS). Using ICD-9-CM codes, we classified acute gastroenteritis (AGE) cases by principal diagnosis fields and then categorized their comorbidities, complications, and epidemiological features by secondary fields. A multivariable, logistic, step-wise regression model was then constructed. We identified 1657 ARGE cases from 17 415 cases of AGE. Rotavirus hospitalizations were associated with place of residence, age, and season (P < 0·0001), as well as with dehydration [odds ratio (OR) 12·44, 95% confidence interval (CI) 1·52-40·38], intravenous rehydration (OR 1·74, 95% CI 1·29-2·35), metabolic acidosis (OR 1·51, 95% CI 1·24-1·83), respiratory tract infections (RTIs) (OR 1·60, 95% CI 1·09-1·98), and concomitant AGE (OR 1·52, 95% CI 1·03-2·25). Dehydration was four times more likely in patients aged <5 years (OR 4·36, 95% CI 1·20-12·96) and was associated with acidosis when ARGE and RTI were present simultaneously (P < 0·0001). Specific co-infecting viruses may play a role in acute respiratory symptoms and aggravation of gastrointestinal manifestations of rotaviruses, thus leading to complications requiring hospitalization.

Prevalencia del aneurisma de aorta abdominal en varones de 65-80 años de una población rural / Prevalence of abdominal aortic aneurysm in a rural population of 65-80 year-old males

Introducción. La prevalencia del aneurisma de aorta abdominal (AAA) es del 3,5-4% en varones mayores de 65 años. Se desconoce si esa prevalencia es extrapolable a una población rural, resultante de las mediciones ecográficas realizadas por médicos de familia. Objetivo. Estimar la prevalencia de AAA en una población rural de varones con edades de 65 a 80 años, mediante ecografía abdominal realizada por médicos de familia e identificar su asociación con diferentes FRV. Sujetos y método. Estudio transversal. Se incluyeron varones de 65 a 80 años (n = 320), de una población rural de la provincia de Ciudad Real. La variable dependiente, presencia o no de AAA, se consideró como un diámetro mayor o igual a 3 cms a la exploración ecográfica. Variables explicativas: índice tobillo/brazo (ITB), índice de masa corporal (IMC), antecedentes de hipertensión arterial (HTA), diabetes mellitus (DM), dislipemia (DLP), cardiopatía isquémica, accidentes cerebrovaculares, tabaquismo. Se realizó un análisis bivariante, multivariante, de prevalencias y además un estudio de concordancia entre observadores. Resultados. La prevalencia de AAA fue 3,3% con un IC95%: 1,1-5,5%. La DM y la DLP presentó una asociación significativa e independiente con el AAA (OR 5,19; IC95% 1,42-18,95). La concordancia entre observadores fue muy alta (CCI 0,96 (IC95% 0,91-0,98). Conclusiones. La prevalencia obtenida es similar a la encontrada en la literatura. Debido al diseño transversal del estudio, tanto FRV como la HTA o la EAP no presentan asociación con el AAA. Se podría crear un programa de detección precoz desde Atención Primaria por médicos de familia para el AAA (AU)

Introduction. The prevalence of aortic aneurysm (AAA) is reported to be 3.55%-4% in men over 65. But it is not known if this prevalence, resulting from ultrasound measurements made by Family Physicians, can be extrapolated to a rural population. Objective. To estimate the prevalence of AAA in a rural population of males aged 65-80 years, using abdominal ultrasound by family physicians, and to identify its association with different cardiovascular risk factors. Subjects and method. A cross sectional study was conducted that included males of 65-80 years (n = 320) in a rural population of the province of Ciudad Real, Spain. The dependent variable was the presence or not of AAA using ultrasound measurements of the aorta. Those with a diameter greater than or equal to 3 cm were considered positive. Explanatory variables were measured; ankle/brachial index (ABI), body mass index (BMI), medical history of high blood pressure (hypertension), diabetes mellitus (DM), dyslipidaemia (DLP), ischemic heart disease, cerebrovascular accidents (CVA), and smoking habits. A bivariate and multivariate analysis of the prevalences was performed, as well as a study of the agreement between observers. Results. The prevalence of AAA in the population was 3.3% (95% CI: 1.1-5.5%. DM and DLP were significantly associated with AAA. The agreement between observers was 0.96 (95% CI; 0.91-0.98). The high prevalence of different cardiovascular risk factors (CVRF) was particularly noteworthy. Conclusions. The prevalence of AAA in 65-80 year-old males in a rural population is similar to that found in the literature. Due to the cross-sectional nature of the study, CVRFs such as hypertension or CVA were not associated with the AAA. A screening program for the early detection of AAA could be introduced into Primary Health Care by family physicians (AU)

[Prevalence of abdominal aortic aneurysm in a rural population of 65-80 year-old males]. / Prevalencia del aneurisma de aorta abdominal en varones de 65-80 años de una población rural.

INTRODUCTION: The prevalence of aortic aneurysm (AAA) is reported to be 3.55%-4% in men over 65. But it is not known if this prevalence, resulting from ultrasound measurements made by Family Physicians, can be extrapolated to a rural population. OBJECTIVE: To estimate the prevalence of AAA in a rural population of males aged 65-80 years, using abdominal ultrasound by family physicians, and to identify its association with different cardiovascular risk factors. SUBJECTS AND METHOD: A cross sectional study was conducted that included males of 65-80 years (n=320) in a rural population of the province of Ciudad Real, Spain. The dependent variable was the presence or not of AAA using ultrasound measurements of the aorta. Those with a diameter greater than or equal to 3cm were considered positive. Explanatory variables were measured; ankle/brachial index (ABI), body mass index (BMI), medical history of high blood pressure (hypertension), diabetes mellitus (DM), dyslipidaemia (DLP), ischemic heart disease, cerebrovascular accidents (CVA), and smoking habits. A bivariate and multivariate analysis of the prevalences was performed, as well as a study of the agreement between observers. RESULTS: The prevalence of AAA in the population was 3.3% (95% CI: 1.1-5.5%. DM and DLP were significantly associated with AAA. The agreement between observers was 0.96 (95% CI; 0.91-0.98). The high prevalence of different cardiovascular risk factors (CVRF) was particularly noteworthy. CONCLUSIONS: The prevalence of AAA in 65-80 year-old males in a rural population is similar to that found in the literature. Due to the cross-sectional nature of the study, CVRFs such as hypertension or CVA were not associated with the AAA. A screening program for the early detection of AAA could be introduced into Primary Health Care by family physicians.

Concordancia interobservador en la detección de bocio por palpación en población escolar / Interobserver agreement in detecting goitre by palpation in a school population

Objetivo: Estimar la concordancia interobservador en la detección de bocio por exploración física en población escolar. Metodología: Se realizó un estudio transversal para la detección de bocio en una muestra representativa de 1.134 escolares de 6 a 12 años de 20 colegios del área de salud de La Mancha Centro. La exploración fue realizada de forma enmascarada por 2 únicos observadores. Se establecieron 5 grados de tamaño tiroideo (0, I a, I b, II y III ). Se consideró bocio a partir del grado i a. La concordancia se valoró en relación con variables como edad, sexo, índice de masa corporal, talla y día de exploración. Se utilizó el índice kappa como medida de concordancia. Resultados: En los 1.097 escolares con doble exploración, en 96 (8,8%) se detectó bocio por el observador 1 y en 102 (9,3%) por el 2 (p = 0,58). El grado de acuerdo interobservador en la identificación y en la graduación del bocio fue moderado (kappa 0,55; IC del 95%, 0,46-0,64) para la primera y sustancial (kappa ponderado 0,61; IC del 95%, 0,51-0,71) para la segunda. Fue algo mayor en las niñas y en los escolares de mayor edad, peso, talla e índice de masa corporal. La concordancia entre observadores fue relativamente estable a lo largo de la realización del estudio. Conclusiones: La concordancia interobservador en la detección de bocio por palpación en nuestro estudio es moderada, aunque más baja en los niños más pequeños e invariable durante todo el periodo en el que se realizó (AU)

Objective: To estimate the agreement between observers on the detection of goitre by physical exploration in a school population. Methodology: We performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III ). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. Results: In the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=0.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95% CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. Conclusions: The interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study (AU)

Relación entre la interfase donante/receptor y la agudeza visual en trasplante corneal tipo DSAEK / Relationship between donor-receptor interface and visual acuity in DSAEK

Objetivo: Evaluar la relación entre la agudeza visual (AV) mejor corregida y la interfase donante-receptor resultante tras realizar una queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK). Métodos: Se revisaron 46 historias clínicas de pacientes intervenidos con técnica DSAEK, de las cuales cumplían criterios de inclusión 22 pacientes (dos de ellos con DSAEK bilateral). Todos ellos fueron intervenidos por un mismo oftalmólogo desde enero del 2010 hasta abril del 2011. Las indicaciones quirúrgicas fueron: queratopatía bullosa 19 (72,2%), distrofia endotelial de Fuchs tres (12,5%) y agotamiento endotelial tras queratoplastia previa dos (8,3%).Se recogió la AV preoperatoria y al tercer y sexto mes postoperatorio, comparándose en estas dos últimas la interfase existente entre donante y receptor tras DSAEK medida en cámara Scheimpflug de topógrafo corneal (Pentacam-HR, Oculus®, Wetzlar, Alemania). Resultados: Tras la cirugía con DSAEK, la mejora en la AV fue en 19 ojos al tercer mes y en 20 ojos al sexto mes postoperatorio (p < 0,001). Dicho cambio en la AV se comparó con la disminución de la densidad óptica de la interfase donante-receptor resultante, encontrando una relación positiva y significativa entre estas (Rho interfase 3 meses y cambio de AV 6 meses: 0,44; p < 0,001). Sin embargo, la interfase se relacionó negativa y significativamente con la AV (Rho 3 m: –0,41; p = 0,045). Además, los pacientes que presentaban un estroma más denso conseguían AV postoperatorias peores en términos relativos si se comparaban con los que presentaban un estroma menos dañado. Conclusiones: Los pacientes sometidos a DSAEK con AV prequirúrgicas peores experimentan una mejora visual mayor en valores absolutos y, sin embargo, alcanzarían una AV menor relativa que se podría relacionar con una interfase más refringente, como consecuencia de un estroma corneal preoperatorio más alterado (AU)

Objective: To evaluate the relationship between best corrected visual acuity and donor-recipient interface resulting after Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK). Methods: Retrospective review of 46 clinical histories after DSAEK intervention in which 22 patients who fulfilled the inclusion criteria (two with bilateral DSAEK), were studied. All were operated on by the same ophthalmologist from January 2010 until April 2011. Surgical indications were: 19 (72.2%) bullous keratopathy, 3 (12.5%) Fuchs endothelial dystrophy, and 2 (8.3%) previous failed keratoplasty.The visual acuity (VA) was recorded preoperatively, and at three and six months after the operation; the latter two being compared with the interface between donor and recipient after DSAEK measured in a Scheimpflug corneal topography camera (Pentacam® model). Results: After DSAEK surgery 19 eyes had improved visual acuity at three months, and 20 eyes at six months (P < 0.001). This improvement was compared with the decrease in optical density of the resulting donor-receptor interface, with apositive and significant relationship being found between them (Rho interface 3 months, and improved AV 6 months 0.44, P <0 .001). However, the interface is negatively and significantly related with visual acuity (Rho 3 m: –0.41, P = 0.045). Also, patients who had a denser stroma had a worse postoperative visual acuity in relative terms when compared with those who had a less damaged stroma. Conclusions: Patients undergoing DSAEK with worse preoperative visual acuity had a greater improvement visual in absolute values and however, they may have achieved a lower relative visual acuity than could be related to a higher refractive interface, as a result of a more damaged preoperative corneal stroma (AU)

[Relationship between donor-receptor interface and visual acuity in DSAEK]. / Relación entre la interfase donante/receptor y la agudeza visual en trasplante corneal tipo DSAEK.

OBJECTIVE: To evaluate the relationship between best corrected visual acuity and donor-recipient interface resulting after Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK). METHODS: Retrospective review of 46 clinical histories after DSAEK intervention in which 22 patients who fulfilled the inclusion criteria (two with bilateral DSAEK), were studied. All were operated on by the same ophthalmologist from January 2010 until April 2011. Surgical indications were: 19 (72.2%) bullous keratopathy, 3 (12.5%) Fuchs endothelial dystrophy, and 2 (8.3%) previous failed keratoplasty. The visual acuity (VA) was recorded preoperatively, and at three and six months after the operation; the latter two being compared with the interface between donor and recipient after DSAEK measured in a Scheimpflug corneal topography camera (Pentacam(®) model). RESULTS: After DSAEK surgery 19 eyes had improved visual acuity at three months, and 20 eyes at six months (P<.001). This improvement was compared with the decrease in optical density of the resulting donor-receptor interface, with apositive and significant relationship being found between them (Rho interface 3 months, and improved AV 6 months 0.44, P<.001). However, the interface is negatively and significantly related with visual acuity (Rho 3 m: -0.41, P=.045). Also, patients who had a denser stroma had a worse postoperative visual acuity in relative terms when compared with those who had a less damaged stroma. CONCLUSIONS: Patients undergoing DSAEK with worse preoperative visual acuity had a greater improvement visual in absolute values and however, they may have achieved a lower relative visual acuity than could be related to a higher refractive interface, as a result of a more damaged preoperative corneal stroma.

Enfermedad mental, rasgos de personalidad y calidad de vida en epilepsia: estudio control de pacientes con epilepsia mioclónica juvenil y otras epilepsias / Mental illness, personality traits and quality of life in epilepsy: control study of patients with juvenile myoclonic epilepsy and other epilepsies

Introducción. La asociación de epilepsia con enfermedad mental está descrita desde hace años. En la actualidad, se intenta relacionar ciertas epilepsias, como la epilepsia mioclónica juvenil (EMJ), con determinados rasgos de personalidad marcados por la inestabilidad afectiva. Sujetos y métodos. Se estudia un grupo de pacientes con EMJ y su estado mental, con especial interés sobre los rasgos de personalidad, la presencia de clínica de ansiedad o depresión, y la calidad de vida, junto con otros pacientes diagnosticados de otras epilepsias, así como frente a un grupo control. Resultados. Los pacientes con epilepsia presentan rasgos de personalidad más marcados, así como síntomas de ansiedad y depresión, y realizan una valoración más negativa de su calidad de vida respecto al grupo control. Los pacientes con otras epilepsias presentan una mayor alteración de la personalidad y una peor percepción de su calidad de vida que los pacientes con EMJ. Conclusiones. Se obtienen diferencias entre los pacientes con epilepsia y el grupo control en todas las variables analizadas (personalidad, ansiedad, depresión y calidad de vida). Los pacientes con EMJ presentan mejores puntuaciones en personalidad y calidad de vida que los pertenecientes al grupo de otras epilepsias (AU)

Introduction. The association of epilepsy with mental illness is described for years. Current is trying to relate certain epilepsies, such as juvenile myoclonic epilepsy (JME) with certain personality traits marked by emotional instability. Subjects and methods. We study a group of patients with JME and his mental state, with emphasis on the personality traits, presence of clinical anxiety or depression and quality of life, with other epilepsy patients versus a control group. Results. Patients with epilepsy have more marked personality traits and symptoms of anxiety and depression, making a more negative assessment of their quality of life than the control group. Patients with others epilepsy have a higher other personality disorder and a poorer perception of their quality of life than patients with JME. Conclusions. Differences are obtained among patients with epilepsy and control groups in all the variables analyzed (personality, anxiety, depression and quality of life). JME patients have better scores on personality and quality of life than those in the other group of epilepsies (AU)

Ajuste del tratamiento farmacológico a las guías de práctica clínica en pacientes octogenarios con infarto agudo de miocardio / Drug treatment adjustment to the clinical guidelines in octagenarians with acute myocardial infarction

Objetivo: Determinar si existe una asociación lineal de la edad y la administración de aspirina ,betabloque antes, inhibidores de la enzima convertidora de la angiotensina y estatinas, en qué medida los pacientes de edad avanzada reciben estos tratamientos y si la edad se asocia de forma independiente a estos tratamientos. Diseño: Estudio de cohortes prospectivo. Ámbito: Unidades Coronarias de 2 hospitales de la Región de Murcia Pacientes: Pacientes consecutivos ingresados con el diagnóstico de infarto agudo de miocardio entre enero de 1998 y enero de 2008.Intervenciones: Ninguna. Variables principales: Las relacionadas con la administración de aspirina, betabloqueantes, inhibidores de la enzima convertidora de la angiotensina y estatinas durante la estancia en la Unidad Coronaria. Resultados: Respecto al resto de pacientes, los octogenarios recibieron en similar proporción inhibidores de la enzima convertidora de la angiotensina (70,8 vs 69,3%, p=0,41) y con menor frecuencia aspirina (90,4 vs 94,6%, p<0,001), betabloqueantes (44,4 vs 69,4%, p<0,001) y estatinas(47,6 vs 64,7%, p<0,001). Solo pudo demostrarse una disminución brusca y significativa en la administración de estatinas a partir de los 80 años. La edad se asoció independientemente con la administración de betabloqueantes (OR 0,59; IC95% 0,47 - 0,73) y estatinas (OR 0,78;IC95% 0,65 - 0,95). La menor administración de estos fármacos también se asoció a una mayor (..) (AU)

Objectives: To determine whether there is a linear association of age and aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and statins; the extent to which elderly patients receive these treatments; and whether age is independently associated with these treatments. Design: A prospective cohort study. Setting: Coronary Unit of two hospitals in the Region of Murcia (Spain).Patients: Consecutive patients admitted with the diagnosis of acute myocardial infarction between January 1998 and January 2008.Interventions: None. Main outcomes: Those related to the administration of aspirin, beta-blockers, angiotens nconverting enzyme inhibitors and statins during stay in the Coronary Care Unit. Results: Regarding the remaining patients, octogenarians received a similar proportion of angiotensin-converting enzyme inhibitors (70.8% vs. 69.3%, p=0.41) and less often aspirin (90.4%vs. 94.6%, p<0.001), beta-blockers (44.4% vs. 69.4%, p<0,001) and statins (47.6% vs. 64.7%,p<0.001). We were only able to demonstrate an abrupt and significant decrease in the use of statins after 80 years of age. Patient age was independently associated with the use of beta blockers (OR 0.59; 95%CI 0.47 - 0.73) and statins (OR 0.78; 95%CI 0.65 - 0.95). The lesser administration of these drugs was also associated with early mortality (OR 0.17, 95%CI 0.09 to0.33 and OR 0.14; 95%CI 0.08 to 0.23, respectively).Conclusions: Octogenarians less often receive aspirin, beta-blockers and statins, though old age was not an independent factor associated with lesser aspirin use (AU)

[Interobserver agreement in detecting goitre by palpation in a school population]. / Concordancia interobservador en la detección de bocio por palpación en población escolar.

OBJECTIVE: To estimate the agreement between observers on the detection of goitre by physical exploration in a school population. METHODOLOGY: We performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. RESULTS: In the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95%CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. CONCLUSIONS: The interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study.

[Drug treatment adjustment to the clinical guidelines in octagenarians with acute myocardial infarction]. / Ajuste del tratamiento farmacológico a las guías de práctica clínica en pacientes octogenarios con infarto agudo de miocardio.

OBJECTIVES: To determine whether there is a linear association of age and aspirin, betablockers, angiotensin-converting enzyme inhibitors and statins; the extent to which elderly patients receive these treatments; and whether age is independently associated with these treatments. DESIGN: A prospective cohort study. SETTING: Coronary Unit of two hospitals in the Region of Murcia (Spain). PATIENTS: Consecutive patients admitted with the diagnosis of acute myocardial infarction between January 1998 and January 2008. INTERVENTIONS: None. MAIN OUTCOMES: Those related to the administration of aspirin, betablockers, angiotensin-converting enzyme inhibitors and statins during stay in the Coronary Care Unit. RESULTS: Regarding the remaining patients, octogenarians received a similar proportion of angiotensin-converting enzyme inhibitors (70.8% vs. 69.3%, p=0.41) and less often aspirin (90.4% vs. 94.6%, p<0.001), betablockers (44.4% vs. 69.4%, p<0,001) and statins (47.6% vs. 64.7%, p<0.001). We were only able to demonstrate an abrupt and significant decrease in the use of statins after 80 years of age. Patient age was independently associated with the use of betablockers (OR 0.59; 95%CI 0.47 - 0.73) and statins (OR 0.78; 95%CI 0.65 - 0.95). The lesser administration of these drugs was also associated with early mortality (OR 0.17, 95%CI 0.09 to 0.33 and OR 0.14; 95%CI 0.08 to 0.23, respectively). CONCLUSIONS: Octogenarians less often receive aspirin, betablockers and statins, though old age was not an independent factor associated with lesser aspirin use.

Revisión sistemática de las evidencias sobre la eficacia de la ultrasonoforesis y la iontoforesis en el síndrome subacromial / A systematic review of the evidence on the efficacy of phonophoresis and iontophoresis in the impingement syndrome

Resumen El objetivo de esta revisión es evaluar las evidencias actuales sobre la eficacia de la aplicación de la iontoforesis y la ultrasonoforesis en el tratamiento del síndrome subacromial. Se realizaron búsquedas de ensayos clínicos en Pubmed, PEDro, Cochrane, Doyma y mRCT. Cinco revisores independientes evaluaron su calidad, basándose en la escala PEDro, diseñada para la evaluación de ensayos fisioterápicos. Cumplieron los criterios de inclusión 3 ensayos clínicos, con variable calidad metodológica, muestras de pequeño tamaño y heterogeneidad de la población a estudio. Sus autores concluyeron que la iontoforesis tiene mayor eficacia y duración del efecto frente a las corrientes interferenciales en tendinitis bicipitales, y que no se ha demostrado que la ultrasonoforesis sea más eficaz que el ultrasonido en patologías de tejidos blandos. Tras esta revisión se concluye que son necesarios ensayos clínicos de mayor calidad metodológica sobre la eficacia de la iontoforesis y ultrasonoforesis en el síndrome subacromial (AU)

Abstract The purpose of this review is to evaluate the currently available evidence on the efficacy of the application of iontophoresis and phonophoresis or ultrasonophoresis in the treatment for impingement syndrome. A search was made of the clinical trials in PubMed, PEDro, Cochrane, Doyma and mRCT. Five independent reviewers assessed the methodological quality of the trials included, based on the PEDro scale specifically designed to assess the validity of the trials on physiotherapy interventions. The inclusion criteria were met by three clinical trials which were of varied methodological quality, small sample size and study population heterogeneity. The authors concluded that iontophoresis has greater efficacy and duration of effect against the interference currents in biceps tendinitis and that it has not been demonstrated that phonophoresis is more effective than ultrasound in soft tissue conditions. Following this review, we conclude that more clinical trials having better methodological quality on the efficacy of iontophoresis and phonophoresis in impingement syndrome are necessary (AU)