A Phase I/IIa Prospective, Randomized, Open-Label Study on the Safety and Efficacy of Nebulized Liposomal Amphotericin for Invasive Pulmonary Aspergillosis.

Although nebulized liposomal amphotericin B (NLAB) is being used in invasive pulmonary aspergillosis (IPA) prophylaxis, no clinical trial has shown its efficacy as a therapeutic strategy. NAIFI is the inaugural randomized, controlled clinical trial designed to examine the safety and effectiveness of NLAB (dosage: 25 mg in 6 mL, three times per week for 6 weeks) against a placebo, in the auxiliary treatment of IPA. Throughout the three-year clinical trial, thirteen patients (six NLAB, seven placebo) were included, with 61% being onco-hematological with less than 100 neutrophils/µL. There were no significant differences noted in their pre- and post-nebulization results of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and oxygen saturation between the groups. Neither bronchospasm nor serum amphotericin B levels were reported in any patients given NLAB. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET-TC) was carried out at the baseline and after 6 weeks. A notable decrease in median SUV (standardized uptake value) was observed in NLAB patients after 6 weeks (-3.6 vs. -0.95, p: 0.039, one tail). Furthermore, a reduction in serum substance galactomannan and beta-D-Glucan was identified within NLAB recipients. NLAB is well tolerated and safe for patients with IPA. Encouraging indirect efficacy data have been derived from image monitoring or biomarkers. However, further studies involving more patients are necessary.

Training Characteristics and Competitive Demands in Women Road Cyclists: A Systematic Review.

PURPOSE: To identify the main training characteristics and competitive demands in women's road cycling. METHODS: A systematic search was conducted on 5 databases according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The articles had to be primary studies, written after 1990 with a sample of competitive women between the ages of 15 and 50. The Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales were used. RESULTS: The search yielded 1713 articles, of which 20 were included. Studies on training and competitive demands (n = 5) found that both external and internal loads are higher in women than in men. Studies on strength and endurance training (n = 5) showed that both velocity-based and heavy-load strength training programs performed at least 2 days per week and including 3 to 4 lower-body exercises improved performance. Altitude-training studies (n = 3) found that "Live High-Train Low" was effective to increase performance during the first 9 days after the training camp. The 7 remaining studies focused on a range of topics. The methodological quality was strong for 12 studies and moderate for 8. In contrast, the level of evidence was high in 7 and low in the other 13. CONCLUSIONS: Endurance training and competitive demands in women's road cycling are higher than those of men. Strength training is effective in women when the frequency, intensity, and number of exercises are appropriate, while altitude training should be completed a few days before competing. Further studies are warranted to better define the participants' competitive level, using a methodological design with a higher level of evidence.

Seguimiento otológico en niños con síndrome de Down / Otological follow-up in children with Down

Introducción y objetivo: La trisomía 21 es la alteración cromosómica más frecuente que a consecuencia del incremento experimentado en su esperanza de vida, requiere unos cuidados más especializados. Las manifestaciones de la esfera ORL representan un foco dominante de morbilidad. Los problemas auditivos son más habituales que en el resto de población, pudiendo mediatizar la evolución educativa y social, afectando su calidad de vida. El objetivo de este trabajo ha consistido en analizar los resultados del seguimiento otológico y auditivo de los niños con síndrome de Down (SD), evaluados en el Servicio de ORL del Hospital Clínico Universitario de Valladolid (HCUV). Método: Estudio longitudinal prospectivo/retrospectivo de 83 niños con SD que acudieron a consulta de hipoacusia infantil entre los años 1993 y 2021. Resultados: Detectamos un 66% de malformaciones de oído externo. La patología de oído medio estuvo presente en el 93%. Se objetivó hipoacusia en el 61%, siendo bilateral en el 78%. El 87% de las diagnosticadas, son de grado leve/moderado y el 6% profundo. La hipoacusia mixta fue el tipo más frecuente, seguida de la neurosensorial. Se realizó cirugía ORL al 62%, destacando la adenoidectomía. Discusión: El seguimiento ORL recomendado para los niños con SD resulta una tarea difícil de organizar, donde se impone desarrollar una planificación específica, que lo haga posible en nuestro sistema público de salud. Conclusiones: Dada la frecuencia e importantes repercusiones de las alteraciones auditivas en los niños con SD, es fundamental la identificación precoz y el seguimiento indefinido, para intentar favorecer su correcto desarrollo. (AU)

Introduction and objective: Trisomy 21 is the most frequent chromosomal alteration and, because of the increase in life expectancy, requires more specialized care. Ear, nose, and throat (ENT) manifestations are a dominant focus of morbidity. Hearing problems are more common when compared to the rest of the population and can impact educational and social development, affecting their quality of life. The aim of this study was to analyze the results of the otological and auditory follow-up of children with Down syndrome (DS), evaluated in the ENT Department of the Hospital Clínico Universitario de Valladolid (HCUV). Method: Prospective/retrospective longitudinal study of 83 children with DS who attended consultation for childhood hearing loss between 1993 and 2021. Results: We detected 66% of external ear malformations. Middle ear pathology was present in 93%. Hearing loss was found in 61%, being bilateral in 78%. Of those diagnosed, 87% were mild/moderate and 6% were profound. Mixed hearing loss was the most frequent type, followed by sensorineural hearing loss. ENT surgery was performed in 62%, with adenoidectomy being the most frequent. Discussion: ENT follow-up recommended for children with DS is a difficult task to organize, as it is necessary to develop specific planning to make it possible in our public health system. Conclusions: Given the frequency and important repercussions of hearing impairment in children with DS, early identification and indefinite follow-up is essential to try to promote their correct development. (AU)

Síndrome de boca ardiente, abordaje otorrinolaringológico. Revisión bibliográfica sistemática / Burning mouth syndrome, otorhinolaryngological approach. Systematic literature review

Introducción y objetivo: El síndrome de boca ardiente (SBA) es una afección crónica, que cursa con quemazón o dolor de la mucosa bucal, afectando predominantemente a mujeres de edad media. Puede aparecer como cuadro primario o bien de forma secundaria. La fisiopatología de esta entidad es bastante desconocida. Existe un amplio abanico terapéutico, pero por lo general precisa de un abordaje multidisciplinar. Nuestra intención es realizar una puesta al día de la enfermedad para poder hacerla frente en la consulta de otorrinolaringología. Método: Revisión bibliográfica de la literatura. Fecha de publicación limitada de 2012 a 2022. Resultados: El SBA presenta una etiopatogenia de carácter multifactorial. Para su diagnóstico es necesario realizar una exhaustiva anamnesis y exploración. Se diferencian 3 tipos distintos de SBA, siendo el tipo II el más frecuente y el más refractario a la terapia. El adecuado tratamiento se fundamenta en un correcto diagnóstico y debe ser multidisciplinar. Discusión: Es importante resaltar que es una entidad benigna. Los tratamientos son variados y no hay ninguno que destaque sobre el resto, lo que dificulta el manejo de estos pacientes. Aunque la bibliografía sobre este síndrome es abundante, no se han producido en los últimos años, importantes innovaciones en cuanto a la etiología y tratamiento. Conclusiones: La anamnesis y los estudios de laboratorio son fundamentales para descartar casusas secundarias de la enfermedad. La terapia es diversa y debe incluir derivación a salud mental como parte del manejo multidisciplinar. (AU)

Introduction and objective: Burning mouth syndrome (BMS) is a chronic condition that causes burning or pain of the oral mucosa, predominantly affecting middle-aged women. It can appear as a primary box or secondary. The pathophysiology of this entity is quite unknown. There is a varied therapeutic range, but it generally requires a multidisciplinary approach. Our intention is to update the disease in order to deal with it in the otorhinolaryngology consultation. Method: Bibliographic review of the literature. Limited release date from 2012 to 2022. Results: BMS has a multifactorial etiopathogenesis. For its diagnosis it is necessary to carry out an exhaustive anamnesis and examination. There are 3 different types of BMS, type II being the most frequent and the most refractory to therapy. Adequate treatment is based on a correct diagnosis and must be multidisciplinary. Discussion: It is important to emphasize that it is a benign entity. The treatments are varied and there is none that stands out above the rest, which makes it difficult to manage these patients. Although the bibliography on this syndrome is abundant, important innovations in terms of etiology and treatment have not been produced in recent years. Conclusions: Anamnesis and laboratory studies are essential to rule out secondary causes of the disease. Therapy is varied and should include referral to mental health as part of multidisciplinary management. (AU)

Otitis externa maligna. Experiencia a lo largo de 25 años en un hospital de tercer nivel / Malignant external otitis. Experience over 25 years at a tertiary referral hospital

Introducción y objetivo: La otitis externa maligna (OEM) es una infección agresiva de los tejidos blandos del oído externo y estructuras circundantes, que puede diseminarse e involucrar la base del cráneo y la articulación temporomandibular (ATM). Afecta fundamentalmente a pacientes inmunodeprimidos mayores de 65 años. El objetivo de este trabajo ha sido conocer las características de los pacientes diagnosticados de OEM en nuestro hospital durante los últimos años y establecer los criterios diagnóstico-terapéuticos de esta rara enfermedad. Método: Se realizó un estudio descriptivo, observacional y retrospectivo, de los pacientes ingresados en el Hospital Clínico Universitario de Valladolid por OEM entre los años 1996 y 2021. Resultados: En los últimos 25 años fueron ingresados por OEM nueve pacientes, 78% varones (7/9) y con una edad media de 76,8 años. Todos manifestaron precozmente la enfermedad, con otalgia, otorrea y tejido de granulación en el conducto auditivo externo (CAE). Ninguno tuvo afectación de pares craneales, pero cuatro sufrieron invasión de la ATM y dos fallecieron. Discusión y Conclusiones: Actualmente el diagnóstico de OEM se establece a partir de una variedad de hallazgos clínicos, de laboratorio y radiográficos. El tratamiento antibiótico depende de la severidad de la infección. Desde la aparición de los antibióticos antipseudomónicos, el tratamiento quirúrgico inicial de esta patología no está indicado, realizándose únicamente biopsia o desbridamiento para el diagnóstico diferencial con patología tumoral. Conclusión: La OEM continúa siendo una enfermedad con grave morbilidad y potencialmente mortal, especialmente en pacientes ancianos y con otras comorbilidades. (AU)

Introduction and objective: Malignant external otitis (MEO) is an aggressive infection of the soft tissues of the external canal and surrounding structures, which can spread and involve the skull base and the temporomandibular joint (TMJ). It mainly affects immunocompromised patients over 65 years of age. The objective of this study has been to know the characteristics of patients diagnosed with MEO in our hospital in recent years and to establish the diagnosis and therapeutic criteria for this rare disease. Method: A descriptive, observational, and retrospective study of patients diagnosed with MEO at the University Clinical Hospital (Valladolid, Spain) between 1996 and 2021 was carried out. Results: Nine patients were diagnosed with MEO in the last 25 years, 78% male (7/9), and with a mean age of 76.8 years. All patients manifested the disease early with otalgia, otorrhea and granulation tissue in the external auditory canal (EAC). None had cranial nerve involvement, but four had TMJ invasion and two of the nine patients in the sample died. Discussion: Currently the diagnosis of MEO is established from a variety of clinical, laboratory and radiographic findings. Antimicrobial therapy depends on the severity of the infection. Since the availability of systemic antipseudomonal antibiotics, surgical treatment of this pathology is not indicated initially, performing only biopsy or debridement for differential diagnosis with tumor pathology. Conclusion: MEO continues to be a disease with serious morbidity and maximum mortality, especially in elderly patients and with other comorbidities. (AU)

Costilla cervical como causa de tumor supraclavicular: revisión sistemática / Cervical rib as a cause of supraclavicular tumour. Systematic review

Introducción y objetivo: El hallazgo de una masa dura supraclavicular conlleva siempre preocupación, porque habitualmente implica un diagnóstico de malignidad. El objetivo de este trabajo ha consistido en examinar las características diferenciales de la presencia de una costilla cervical que, aun siendo una entidad muy poco frecuente, si se sospecha clínicamente, hace posible un diagnóstico inmediato, evitando exploraciones innecesarias y ofreciendo al paciente un pronóstico de benignidad. Método: Se realiza una revisión sistemática sobre el diagnóstico diferencial de las masas duras supraclaviculares, por dos revisores independientes utilizando cinco buscadores académicos distintos. Resultados: De los 96 artículos obtenidos en la búsqueda inicial, se han extraído 14, tras el cribado de los que no cumplían los criterios de inclusión. El enfoque de los trabajos seleccionados fue el diagnóstico diferencial de una costilla cervical en pacientes con una masa dura supraclavicular. Discusión: La solicitud de pruebas complementarias, retrasa un diagnóstico que puede realizarse con una radiografía simple de tórax, evitando al paciente la angustia de un tortuoso camino. Conclusión: En el diagnóstico diferencial de una masa dura supraclavicular, se debe incluir la posibilidad de una costilla cervical. (AU)

Introduction and objective: Discovering a hard supraclavicular mass is a worrisome finding because it usually implies an underlying malignancy. The objective of this work is to illustrate the clinical presentation and characteristics of a cervical rib, because as unusual as this entity may be, suspecting of it offers an immediate diagnosis, avoids unnecessary explorations and presents a benign diagnosis to the patient. Method: A systematic review about the differential diagnosis of hard supraclavicular masses is carried out by two independent revisers using five different academic search engines. Results: From the 96 articles found in the initial search, 14 that matched the inclusion criteria were chosen. The approach of these selected articles was the differential diagnosis of a cervical rib in patients with a hard supraclavicular mass. Discussion: Soliciting complimentary tests delays a diagnosis that can be easily made through a simple thorax radiography, saving the patient from the distress of tortuous pathway. Conclusions: The differential diagnosis of a hard supraclavicular mass should include the possibility of a cervical rib. (AU)

Costilla cervical: tres casos para ilustrar su presentación clínica / Cervical rib: three cases to illustrate its clinical presentation

Introducción y objetivo: La costilla cervical se manifiesta clínicamente como una tumoración de dureza pétrea en la región supraclavicular, que puede sugerir inicialmente malignidad. El objetivo de este trabajo es ilustrar su presentación, para facilitar la sospecha clínica y el diagnóstico, ofreciendo al paciente un pronóstico benigno. Método: Se presentan tres casos clínicos diagnosticados de costilla cervical en el servicio de ORL de nuestro hospital. Discusión: Los datos de la anamnesis, la exploración clínica y una radiografía simple de tórax, deberían ser indicios suficientes, para diferenciar esta entidad de un proceso maligno. Conclusiones En el diagnóstico diferencial de una masa dura supraclavicular, debemos pensar en la posibilidad de una costilla cervical. (AU)

Introduction and objective: A cervical rib clinically manifests as a hard supraclavicular lump, which may initially suggest malignancy. The objective of the present work is to illustrate its presentation, to make the suspicion and diagnosis of it easier and thereby offering the patient a benign diagnosis. Method: We present three clinical cases of cervical rib seen in the ENT service of our hospital. Discussion: Information from the clinical interview and physical exam along with a simple thorax radiography should be sufficient to distinguish this entity from a malignant process. Conclusions: In the differential diagnosis of a hard supraclavicular mass, we should consider the possibility of a cervical rib. (AU)

Relationship between competency for evidence-based practice and level of burnout of physical therapists with the establishment of the therapeutic relationship.

BACKGROUND: Evidence-based practice (EBP) interventions and effective therapeutic alliance (TA) are associated with greater treatment success. Furthermore, burnout syndrome could be detrimental to the development of such TA. OBJECTIVE: To examine the association between EBP competencies and burnout level with the quality of TA among Spanish physiotherapists. METHODS: Cross-sectional research with an electronic survey including the EBP Questionnaire-19, Maslach Burnout Inventory and Working Alliance Inventory-Short (WAI-S) and administered to 471 physiotherapists. RESULTS: Regarding the EBP Questionnaire-19, physiotherapists scored highest on attitude and lowest on knowledge. For WAIS which achieved appropriate results of internal consistency and validity in the sample analyzed, bond scored the highest and goals the lowest. Years of experience was significantly associated with the task (r = 0.5; p = .003) and bond (r = 0.7; p = .002) and the WAIS total score (r = 0.8; p < .001), and all burnout subscales (-0.7 < r > 0.7; p < .001 for all). CONCLUSION: Lower levels of burnout and improved EBP competencies are associated with a TA of greater quality. The association between attitudes toward EBP, a higher level of self-confidence and a lower perception of depersonalization appear to be determinant factors for improving TA.

Tricofoliculoma del conducto auditivo externo. Revisión bibliográfica / Trichofolliculoma in the external auditory canal. Bibliographic review

Introducción y objetivo: El tricofoliculoma es un tumor anexial de los folículos pilosos que excepcionalmente puede presentarse en el conducto auditivo externo. El objetivo de este artículo es revisar la bibliografía publicada sobre el tricofoliculoma localizado en el conducto auditivo externo a propósito de un caso diagnosticado en nuestro centro. Método: Revisión bibliográfica por dos revisores independientes en mayo 2020 en bases de datos actualizadas. Resultados: En la literatura se hallaron seis casos clínicos publicados de tricofoliculoma en conducto auditivo externo. Conclusiones: El diagnóstico histológico de tricofoliculoma de conducto auditivo externo. (AU)

Introduction and objective: Trichofoliculoma is an adnexal tumor of the hair follicles that may exceptionally occur in the external auditory canal. The objective of this article is to review the published literature on trichofoliculoma located in the external auditory canal about a case diagnosed in our center. Method: Literature review by two independent reviewers in May 2020 in updated databases. Results: In the literature, six published clinical cases of trichofoliculoma in the external auditory canal were found. Conclusions: The histological diagnosis of trichofoliculoma of the external auditory canal. (AU)

Tricofoliculoma del conducto auditivo externo. Un caso excepcional de presentación agresiva / Trichofolliculoma of the external auditory canal, an exceptional case of aggressive presentation

Introducción: El tricofoliculoma es una tumoración anexial, infrecuente y benigna, de los folículos pilosos, cuya localización en el conducto auditivo externo (CAE) es excepcional. Objetivo: Describir y actualizar, las características clínicas y evolutivas del tricofoliculoma del CAE a través de un caso clínico. Caso clínico: Mujer de 47 años con una tumoración agresiva del CAE, que destruía la mastoides, cuyo estudio histopatológico, tras la cirugía, ofreció el diagnóstico de tricofoliculoma, asociado a un colesteatoma, Discusión y conclusiones: El tricofoliculoma es un raro tumor de los folículos pilosos, cuya localización en el CAE es excepcional. El comportamiento agresivo del caso presentado quizá fuera debido a su asociación con un colesteatoma, de probable origen secundario. (AU)

Introduction and objective: Trichofolliculoma is a rare and benign adnexal tumour of the hair follicles. The location of this tumour in the external auditory canal (EAC) is exceptional. Its diagnosis is histopathological. Objective: Present an exceptional clinical case, the finding of a trichofolliculoma in the external auditory canal. Clinical case: We present the clinical case of a CAE trichofolliculoma that, when associated with a cholesteatoma, had an aggressive manifestation with destruction of the temporal bone. Conclusion: Trichofolliculoma is a rare tumour of the hair follicles whose location in the EAC is exceptional. The aggressive behaviour of the case presented was due to its association with a cholesteatoma, probably secondary to the obstruction and recurrent inflammatory processes of the tumour. (AU)

The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study.

BACKGROUND: The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance. OBJECTIVE: The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them. DESIGN: Cross-sectional research. METHODS: An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out. RESULTS: Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01). CONCLUSIONS: The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.

Musculoskeletal Pain and Teleworking in Times of the COVID-19: Analysis of the Impact on the Workers at Two Spanish Universities.

The special situation brought about by the coronavirus pandemic and the confinement imposed by the Government, has given rise to numerous changes in working habits. The workers at the universities have had to start a period of teleworking that could give rise to consequences for the musculoskeletal system. The objective of this article is to analyze the impact of the confinement on the musculoskeletal health of the staff of two Spanish universities. A cross-sectional, observational study was carried out on the workers. Data was taken in April-May 2020 and included: The Standardized Kuorinka Modified Nordic Questionnaire, the Perceived Stress Scale and another one on sociodemographic data. This study comprised 472 people. The areas of pain noted during the confinement period concluded that it was less in all cases (p < 0.001). The frequency of physical activity carried out increased significantly during the period of confinement (p < 0.04), especially in women. The type of physical activity done was also seen to modify during this period (p < 0.001), with a preference for strength training and stretching exercises. In conclusion, the confinement gave rise to changes in the lifestyle and in the musculoskeletal pain of the workers at the universities. All of this must be taken into account by health institutions and those responsible for the Prevention of Occupational Risks at Spanish universities.

Significant socio-emotional learning and improvement of empathy in physiotherapy students through service learning methodology: A mixed methods research.

BACKGROUND: Research into service learning (SL) in education has increased since the 1990s. In higher education physiotherapy programmes, this technique is used to achieve real practical learning and to grasp how to recognize and manage emotions, to be concerned for others and to take decisions in clinical contexts. OBJECTIVES: To create a community experience through SL methodology for physiotherapy university students and to analyse their perceptions of the learning experience and changes in empathy. DESIGN: A mixed research method, a quasi-experimental quantitative approach with pre- and post-measurements of a single group and a qualitative approach through reflective diaries subjected to a contents analysis. PARTICIPANTS: 29 students of the Faculty of Health Sciences (Department of Nursing and Physiotherapy) designed and put into practice a workshop for promoting physical activity in 277 children from the first and the sixth year of compulsory primary education. METHODS: The project was divided into three phases: planning, performing and reflecting on the service. At the start, participants completed a questionnaire to determine their scale of empathy on the Interpersonal Reactive Index (IRI). One week after performing the service they handed over reflective diaries and completed a second IRI scale survey. An analysis was carried out of the contents of the reflective diaries. RESULTS: Twenty-nine students agreed to participate. These learners consolidated their skills in the subject, indicating their satisfaction with the significant learning they achieved. The IRI scale showed a significant improvement in the Personal Distress dimension (p = 0.002). CONCLUSIONS: Active learning in the context of processes of a participatory and reflective type implies greater understanding of the phenomenon studied. It allows an enhance awareness of the importance of inclusivity and involvement of users in the context of clinical practice. It also provides socio-emotional learning, improving interpersonal abilities and the capacity to face up to stressful situations.

Effectiveness of the application of massage therapy and kinesitherapy by parents on premature neonates: A research protocol.

AIM: The study aims to analyse the efficacy of massage therapy and kinesitherapy applied by parents of premature infants admitted to hospital. BACKGROUND: Premature newborns suffer early somatic deprivation that has adverse effects on their growth and development and that also has a negative impact on the emotional state of their parents. Massage therapy and kinesitherapy is beneficial in alleviating somatic deficit and facilitates the bond between parents and newborns. DESIGN: A quasi-experimental community intervention trial will be conducted in a neonatology unit. METHODS: This study will compare the benefits of a 15-min massage protocol applied by parents with the usual medical and nursing care given by neonatal units for premature babies. The evaluation of neuromotor development will take place through the Spanish Premie-Neuro scale. The determination of weight, size, and head circumference will be based on the unit's usual procedures. DISCUSSION: If the implementation of a massage therapy and kinesitherapy protocol is effective in promoting the growth and development of hospitalized premature infants, the results of this study could give an impetus for the inclusion of somatic stimulation in the usual nursing care given for preterm infants. IMPACT: Prematurity and its associated morbidity pose a major global public health problem. Somatic and kinaesthetic stimulation has beneficial effects on anthropometric and neuromotor development in preterm infants. The results will have a positive impact on premature neonates and their families, both during the hospitalization, and a positive socio-economic effect throughout their lives (education, work, disability). TRIAL REGISTRATION: NCT03704012.

Evolución de úlcera digital por presión utilizando terapia plasma rico en plaquetas con coágulo / No disponible

La cura de úlceras plantea un problema tanto por su cronicidad como por el gasto económico que conllevan. Los estudios que se vienen realizando tratan de encontrar nuevas formas en la cura de úlceras de las distintas etiologías, entre estos estudios destaca la cura de úlceras utilizando plasma rico en plaquetas con diferentes formas de administración. Tras la lectura de diferentes protocolos y formas de cura, se decidió tratar a una paciente con una úlcera digital por presión crónica de 6 semanas de evolución, que no mejoraba con tratamientos convencionales. Se utilizó la técnica de cura mediante coágulo de plasma rico en plaquetas, se extrajo sangre periférica, se preparó el coagulo y se colocó sobre la úlcera con una cura de 5 días de duración. Los resultados obtenidos fueron muy satisfactorios y en pocas semanas la úlcera estaba completamente cerrada presentando una pequeña herida que se descargó y curó con antiséptico local

The cure of ulcers poses a problem as much for its chronicity as for the economic cost that they entail. The studies that are being carried out try to find new ways in the cure of ulcers of the different etiologies, among these studies highlights the cure of ulcers using platelet-rich plasma with different forms of administration. After the reading of different protocols and forms of cure, it was decided to treat a patient with a digital ulcer by chronic pressure of 6 weeks of evolution, which did not improve with conventional treatments. The technique of cure by clot of platelet-rich plasma was used, peripheral blood was extracted, the clot was prepared and placed on the ulcer with a 5-day cure. The results obtained were very satisfactory and in a few weeks the ulcer was completely closed presenting a small wound that was discharged and cured with local antiseptic

[Not Available]. / Diagnóstico y tratamiento del hábito tabáquico en pacientes con EPOC. Estudio ADEPOCLE.

Introducción: estimar la prevalencia del tabaquismo y analizar cómo se diagnostican y se trata a los fumadores diagnosticados de EPOC.Métodos: estudio epidemiológico, transversal, multicéntrico (30 centros salud de la provincia de León). Incluyó pacientes mayores de 35 años diagnosticados y tratados de EPOC. Variables analizadas: edad, sexo, hábitat, datos antropométricos, tabaquismo, número de paquetes/año, cooximetría, dependencia (escala analógico-visual), motivación (test de Fagerström), autoeficacia, estado anímico, intentos previos, terapia cognitivo-conductual, tratamiento farmacológico (TSN, bupropión, vareniclina) y recaídas. Los resultados se expresan con sus IC al 95,5%.Resultados: se incluyó a 833 pacientes, el 85,8% varones, edad media: 64,69 (53,66-75,61) años y 20,65 (4,47-36,8) años de evolución de la EPOC. El 86,67% (80,30-93,30) tenían antecedentes de tabaquismo (n = 722), de 35,26 (17,87-52,64) años de evolución, con consumo medio 28,36 (9,60-46,86) paquetes año, p < 0,001, siendo el 58% fumadores severos. El 57,4% (53,90-60,60) son exfumadores. El 29,3% (26,40-32,70) fumadores activos declarados vs. 35,11% (33,90-37,12) fumadores diagnosticados por cooximetría p < 0,05. Los 288 fumadores activos, presentaban baja motivación (49,80%), alta dependencia (49,5%), actitud negativa (52,60%), bajo estado de ánimo (32,05%), con 2,72 (1,74-3,67) intentos para dejar de fumar, p < 0,0001. La terapia conductivo-conductual (TCC) combinado con tratamiento farmacológico se realizó en el 55,8% (52,2-54,9), p < 0,05; La intervención más efectiva fue TCC combinada con vareniclina logrando una abstinencia del 29,86%. En total dejaron de fumar un 51,05% (49,49-52,70) de los pacientes con EPOC, p < 0,001.Conclusiones: la prevalencia de tabaquismo en la EPOC en nuestro medio continúa siendo inadmisiblemente elevada. Es necesaria una mayor implicación para disminuir su impacto en la salud de estos pacientes.

Diagnóstico y tratamiento del hábito tabáquico en pacientes con enfermedad pulmonar obstructiva crónica. Estudio ADEPOCLE / Diagnosis and treatment of smoking in patients with chronic obstructive pulmonary disease. ADEPOCLE study

Introducción y objetivos: El tabaco es la principal causa de enfermedad pulmonar obstructiva crónica (EPOC). El objetivo de este estudio es estimar la prevalencia del tabaquismo y analizar cómo se diagnostican y se trata a los fumadores diagnosticados de EPOC. Métodos: estudio epidemiológico, transversal, multicéntrico (30 centros salud de la provincia de León). Incluyó pacientes mayores de 35 años diagnosticados y tratados de EPOC. Variables analizadas: edad, sexo, hábitat, datos antropométricos, tabaquismo, número de paquetes/año, cooximetría, dependencia (escala analógico-visual), motivación (test de Fagerström), autoefi cacia, estado anímico, intentos previos, terapia cognitivo-conductual, tratamiento farmacológico (TSN, bupropión, vareniclina) y recaídas. Los resultados se expresan con sus IC al 95,5%. Resultados: se incluyó a 833 pacientes, el 85,8% varones, edad media: 64,69 (53,66-75,61) años y 20,65 (4,47-36,8) años de evolución de la EPOC. El 86,67% (80,30-93,30) tenían antecedentes de tabaquismo (n = 722), de 35,26 (17,87-52,64) años de evolución, con consumo medio 28,36 (9,60-46,86) paquetes año, p < 0,001, siendo el 58% fumadores severos. El 57,4% (53,90-60,60) son exfumadores. El 29,3% (26,40-32,70) fumadores activos declarados vs. 35,11% (33,90-37,12) fumadores diagnosticados por cooximetría p < 0,05. Los 288 fumadores activos, presentaban baja motivación (49,80%), alta dependencia (49,5%), actitud negativa (52,60%), bajo estado de ánimo (32,05%), con ,72 (1,74-3,67) intentos para dejar de fumar, p < 0,0001. La terapia conductivo-conductual (TCC) combinado con tratamiento farmacológico se realizó en el 55,8% (52,2-54,9), p < 0,05; La intervención más efectiva fue TCC combinada con vareniclina logrando una abstinencia del 29,86%. En total dejaron de fumar un 51,05% (49,49-52,70) de los pacientes con EPOC, p < 0,001. Conclusiones: la prevalencia de tabaquismo en la EPOC en nuestro medio continúa siendo inadmisiblemente elevada. Es necesaria una mayor implicación para disminuir su impacto en la salud de estos pacientes (AU)

Background and objectives: Smoking is the main cause of chronic obstructive pulmonary disease (COPD). The objective of this study is to estimate the prevalence of smoking and analyze how the COPD smokers are diagnosed and treated. Methods: Multicenter, epidemiological, transversal study (30 health centers in the province of Leon, Spain). It included patients over 35 years old diagnosed and treated for COPD. The analyzed variables are: age, sex, habitat, anthropometric data, smoking, pack-years cooximetry, dependence (analog-visual scale), motivation (Fagerström test), self-effi cacy, mood, previous attempts, cognitive behavioral therapy, pharmacotherapy (NRT, bupropion, varenicline) and relapses. Results are expressed with CI 95.5%. Results: 833 patients were included. 85.8% males; mean age: 64.69 (53.66-75.61) years and 20.65 (4.47-36.8) years of COPD evolution. The 86.67% (80.30-93.30) had previous history of tabaquism (n = 722) with 35.26 (17.87-52.64) years of evolution and an average consumption of 28.36 (9.60-46.86) packs per year p < 0.001, 58% being heavy smokers. 57.4% (53.90-60.60) are former smokers. 29.3% (26.40-32.70) Smoking declared assets vs. 35.11% (33.90-37.12) smokers diagnosed by cooximetry p < 0.05. 288 active smokers had low motivation (49.80%), high dependence (49.5%), negative attitude (52.60%), low mood (32.05%), with 2.72 (1.74-3.67) attempts to quit smoking, p < 0.0001. The conductive-behavioral therapy (CBT) combined with drug treatment was performed in 55.8% (52.2 to 54.9), p < 0.05; the most effective intervention was CBT combined with varenicline achieving an abstinence of 29.86%. A total of 51.05% (49.49 to 52.70) out of the patients with COPD stopped smoking, p < 0.001. Conclusions: The prevalence of smoking in COPD in our environment remains unacceptably high. Greater involvement is required to reduce its impact on the health of these patients (AU)

Una historia de éxito: nuevas reglas y menos lesiones en la Lucha Leonesa (2005-2012) / A success story: New rules and fewer injuries in traditional Leonese Wrestling (2006-2012)

Objective: To analyse the effectiveness of a change in the rules on the incidence of injuries in traditional Leonese Wrestling (LW). Material and methods: Cohort study, retrospective (2006–2007) and prospective (2008–2012). The population studied comprised all the male wrestlers over 16 years of age who took part in Winter League competitions in the seasons 2006–2012. Data collected included the number, location and severity of injuries. Classifying them according to location and severity, the incidence of injuries by bouts and falls before and after the change was calculated. The formula for calculating effectiveness was: 1 - relative risk. Results: Over the 7 seasons, a total of 34 injuries were reported - 9 in the seasons before the change and 25 afterwards. Since the introduction of the new regulations in 2008, no serious upper limb injuries have been reported. Before the change in rules there was an incidence of 10.4 per 1000 bouts and 3.9 for every 1000 falls, the differences being statistically significant (P = 0.002 and P = 0.006, respectively). The effectiveness in reducing the incidence of serious injuries was 94% by bouts, and 91% by falls. Conclusions: The results of this study confirm the importance of a methodological approach for the prevention of injuries; in this case a change in the rules (AU)

Objective: To analyse the effectiveness of a change in the rules on the incidence of injuries in traditional Leonese Wrestling (LW). Material and methods: Cohort study, retrospective (2006–2007) and prospective (2008–2012). The population studied comprised all the male wrestlers over 16 years of age who took part in Winter League competitions in the seasons 2006–2012. Data collected included the number, location and severity of injuries. Classifying them according to location and severity, the incidence of injuries by bouts and falls before and after the change was calculated. The formula for calculating effectiveness was: 1 – relative risk. Results: Over the 7 seasons, a total of 34 injuries were reported — 9 in the seasons before the change and 25 afterwards. Since the introduction of the new regulations in 2008, no serious upper limb injuries have been reported. Before the change in rules there was an incidence of 10.4 per 1000 bouts and 3.9 for every 1000 falls, the differences being statistically significant (P = 0.002 and P = 0.006, respectively). The effectiveness in reducing the incidence of serious injuries was 94% by bouts, and 91% by falls. Conclusions: The results of this study confirm the importance of a methodological approach for the prevention of injuries; in this case a change in the rules (AU)

Introducción: El objetivo de nuestro estudio es analizar la efectividad de un cambio de reglamento en la incidencia de lesiones de Lucha Leonesa. Material y métodos: Estudio de cohorte retrospectivo (2006-2007) y prospectivo (2008-2012). La población estudiada comprendió todos los luchadores masculinos de más de 16 años que participaron en las Ligas de Invierno en las temporadas del 2006-2012. Se recogieron datos sobre el número, la localización y la severidad de las lesiones, clasificándolos según su localización y su gravedad. Se calculó la incidencia de lesiones por combates y por caídas antes y después del cambio de reglamento. La fórmula para calcular la efectividad fue: 1 - Riesgo Relativo. Resultados: En las 7 temporadas, se registraron un total de 34 lesiones, 9 antes del cambio de reglamento y 25 después. Desde la introducción de las nuevas reglas en 2008 no se produjo ninguna lesión grave en los miembros superiores, mientras que antes del cambio de reglamento la incidencia de lesiones fue de 10,4 por cada 1000 combates y de 3,9 por cada 1000 caídas, siendo estadísticamente significativa (p= 0,002 y p=0,006). La efectividad de la reducción de la incidencia de lesiones graves fue del 94% por combates y del 91% por caídas. Conclusiones: Los resultados de este estudio confirman la importancia de un enfoque metodológico para la prevención de lesiones; en este caso, los cambios de reglamento (AU)