Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre.

Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.

¿Influye el medio de preservación del injerto en los resultados y costos del trasplante hepático de donante fallecido?: Comparación de dos soluciones de preservación / Outcomes using two preservation solutions (UW/HTK) in liver transplantation from brain death donors

Background: Preservation solutions are critical for organ transplantation. In liver transplant (LT), the solution developed by the University Of Wisconsin (UW) is the gold-standard to perfuse deceased brain death donor (DBD) grafts. Histidine-Tryptophan-Ketoglutarate (HTK), formerly a cardioplegic infusion, has been also used in solid organ transplantation. Aim: To compare the outcomes of LT in our center using either HTK or UW solution. Patients and Methods: Retrospective study including 93 LT DBD liver grafts in 89 patients transplanted between March 1994 and July 2010. Forty-eight grafts were preserved with UW and 45 with HTK. Donor and recipient demographics, total infused volume, cold ischemia time, post-reperfusion biopsy, liver function tests, incidence of biliary complications, acute rejection and 12-month graft and patient survival were assessed. Preservation solution costs per liver graft were also recorded. Results: Donor and recipient demographics were similar. When comparing UW and HTK, no differences were observed in cold ischemia time (9.6 ± 3 and 8.7 ± 2 h respectively, p = 0.23), biliary complications, the incidence of acute rejection, primary or delayed graft dysfunction. Histology on post-reperfusion biopsies revealed no differences between groups. The infused volume was significantly higher with HTK than with UW (9 (5-16) and 6 (3-11) l, p < 0.001). The cost per procurement was remarkably lower using HTK. Conclusions: Perfusion of DBD liver grafts with HTK is clinically equivalent to UW, with a significant cost reduction.

Revisión sistemática de utilidades relacionadas con la salud en España: el caso de la salud mental / Systematic review of health-related utilities in Spain: the case of mental health

Objetivo Dada la carencia de un registro de utilidades en población española para su uso en evaluaciones económicas, se desarrolló una revisión sistemática de utilidades o preferencias por estados de salud obtenidas de población española con el fin último de crear un catálogo accesible a los investigadores. En este artículo se detallan las utilidades relacionadas con la salud mental. Método Revisión sistemática de la literatura, con búsquedas en MEDLINE, CRD, Embase, PsycINFO, CINAHL, Cochrane y otras bases de datos. La estrategia de búsqueda combinó términos relacionados con utilidades y con España. Los criterios de inclusión eran población residente, afectada o no por alguna enfermedad; utilidades valoradas con cuestionarios validados en España (EQ-5D, HUI, SF-6D) o siguiendo técnicas directas (equivalencia temporal, standard gamble, escala visual analógica). Se realizó una síntesis narrativa de los artículos incluidos, detallando los resultados relacionados con problemas de salud mental. Resultados Se incluyeron 103 estudios, de los que se extrajeron 742 utilidades. Se identificaron 69 utilidades relacionadas con trastornos mentales y del comportamiento, extraídas de 12 estudios. El instrumento más empleado fue el cuestionario EQ-5D. Gran parte de los artículos excluidos evaluaba la calidad de vida, pero sin ofrecer el valor de la utilidad. Conclusiones La presente revisión añade valor al estudio de las utilidades en España mediante la recopilación de valores que puedan ser incluidos en evaluaciones económicas, permitiendo además identificar lagunas en la investigación en este campo. Los valores relacionados con la salud mental identificados se asemejan a otros informados en la literatura internacional (AU)

Objectives Currently, there is no registry of utility values for the Spanish population that could potentially be used in economic evaluations. Consequently, a systematic review of utilities or preferences for health states in the Spanish population was conducted. The results related to mental health are reported. Methods A systematic review of the literature was conducted. The main databases searched were MEDLINE, CRD, Embase, PsycINFO, CINAHL, and Cochrane. The search strategy combined terms related to utilities and Spain. The inclusion criteria comprised the resident population in Spain, whether affected by any disease or not; the reported utilities had to be evaluated through a tool validated in Spain (i.e., EQ-5D, HUI, SF-6D) and/or following accepted techniques (e.g., time trade-off, standard gamble, or the visual analog scale). A narrative synthesis of articles was undertaken and the results related to mental health summarized. Results A total of 103 articles were finally included, from which 742 utility values were extracted. Sixty-nine utility values related to mental health and behavioral disorders were extracted from 12 studies. The most widely used tool was the E5-QD questionnaire. Most of the excluded articles evaluated quality of life but did not provide an estimation of utilities. Conclusions This review adds value to research on utilities in Spain by gathering values to be included in economic evaluations, as well as by identifying research gaps in this field. The utility values related to mental health identified in this study are similar to those reported in international publications (AU)

Una experiencia educativa basada en los clickers / An educational experience based on clickers

El aprendizaje activo o autónomo aumenta la participación del estudiante y su compromiso con los estudios, condiciones necesarias para mejorar sus resultados académicos. Se ha diseñado una intervención basada en la experiencia del uso de clickers en otras universidades, aunque sin disponer tecnología propia. Se programaron tres sesiones donde se exponían preguntas del tipo multirrespuesta sobre una materia denominada «no presencial» en la que no se imparten clases magistrales. Las respuestas se recogían en plantillas hechas en papel. Se pretendía conocer el grado de relación entre la asistencia a las sesiones y los resultados obtenidos por los estudiantes en el examen final de la asignatura, así como en las preguntas dedicadas a evaluar esa materia «no presencial». Los resultados avalan una diferencia estadísticamente significativa en las respuestas acertadas por los estudiantes según el número de sesiones a las que acudieron. Estas diferencias fueron máximas entre aquellos estudiantes que no asistieron a ninguna sesión y aquellos otros que lo hicieron a las tres sesiones proyectadas (AU)

Active learning or self-learning increases the student’s participation and commitment to his studies; these conditions are necessary to improve academic performance. An intervention has been designed based on the experience in the use of clickers in other universities, but without the actual technology. This work has been performed in the School of Nursing affiliated to the University of Malaga (UMA) on students enrolled in their second year of Degree in Adult Nursing Course I. Three sessions of multiple-choice questions were scheduled on the subject «distance learning» in which master classes were not taught. The answers were collected on paper templates. We wanted to determine the degree of relationship between the attendance of sessions and the results obtained by students in the final examination of the subject, as well as, the questions dedicated to assess the «distance learning» matter. The results support a significant statistical difference in the correct answers by students according to the number of sessions attended. These differences are highest among students who did not attend any session and those who attended the three planned sessions (AU)

Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda: caso clínico / Intravascular hypothermia for the management of Intracranial hypertension in acute liver failure: case report

Acute liver failure has a mortality rate in excess of 80 percent. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization.

Complicaciones neurológicas en pacientes adultos sometidos a trasplante hepático ortotópico: experiencia de un centro universitario / Neurological complications following a liver transplantation: experience from a Chilean center

Background: Orthotopic liver transplantation (OLT) is the treatment of choice for multiple acute and chronic end-stage liver diseases as well as for selected cases of liver malignancy and ¡iver-site metabolic disorders. Neurological impairment is a major source of morbidity and moñality following OLT. Aim: To describe the incidence and the type of neurological complications occurring in the post-operative period of OLT in patients transplanted in our hospital. Material and methods: Between March 1994 and August 2007, 76 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications have been obtained from our program data base and patient charts. Results: Twenty three patients (30.3 percent) had CNS complications following OLT. The leading complications were immunosuppressive drug-related neurological impairment in nine patients (39.1 percent), peripheral nerve damage in five patients (21.7 percent), central pontine myelinolysis in four patients (17.4 percent), cerebrovascular disease in three (13 percent) and CNS infection in three (13 percent). Most CNS events (90 percent) occurred in the first 2 weeks after OLT. Five patients with neurological complications died (22 percent). Conclusions: CNS complications occurred in almost one fifth of the population studied, and they had a poor outcome, as previously reported).

Tratamiento del paciente con carcinoma de próstata en progresión bioquímica resistente a castración / Treatment of the patient with castration-resistant biochemical progression of prostate cancer

El carcinoma de próstata resistente a castración (CPRC) se define como la progresión tumoral a pesar de unos niveles eficaces de castración. (testosterona sérica < 50 ng/dL). La progresión bioquímica requiere al menos dos incrementos sucesivos en la cifra de antígeno prostático específico (PSA), separados al menos una semana, y con un valor mínimo de 2 ng/mL. In pacientes con bloqueo androgénico completo, se debe suspender al antiandrógeno antes del diagnóstico de CPRC. El CPRC es una entidad heterogénea. El valor basal de PSA y la velocidad de PSA parecen ser los factores pronósticos más importantes en pacientes con recidiva bioquímica como única manifestación del CPRC. Algunos de estos pacientes pueden ser seguidos sin tratamiento hasta la progresión de la enfermedad. Debido a que un gran porcentaje de tumores que progresan a pesar de la castración siguen siendo hormonodependientes, el empleo de otras terapias hormonales ha sido el tratamiento preferido para la mayoría de estos pacientes. Junto con los inhibidores de la esteroidogénesis suprarrenal, se están investigando actualmente otros enfoques más novedosos para inhibir el efecto del receptor androgénico activado sobre la célula tumoral. Recientemente, ha habido un importante desarrollo de la inmunoterapia, que ha demostrado incrementar la supervivencia en pacientes con CPRC oligosintomáticos. La quimioterapia de primera y segunda línea en CPRC se asocia con incremento de supervivencia, pero generalmente se recomienda para pacientes con metástasis. Hasta que estén disponibles los resultados de ensayos clínicos actualmente en marcha, el tipo y secuencia de tratamientos para los pacientes con CPRC y recaída bioquímica debe realizarse de forma individualizada(AU)

Castration resistant prostatic carcinoma (CRPC) is defined as tumor progression despite an effective castration (serum testosterone levels < 50 ng/dL). Biochemical progression requires at least two successive increases from the previous lowest value of serum prostate-specific antigen (PSA) spaced at least a week, and with a minimum value of 2 ng/mL. In patients receiving complete androgen blockade, antiandrogen should be discontinued prior to diagnosis of CRPC. CPRC is a heterogeneous entity. Baseline PSA and PSA velocity seem to be the most important prognostic factors in patients with biochemical relapse as the only manifestation of CRPC. Some of these patients can be followed without treatment until disease progression. Because of a large proportion of tumors progressing under androgen deprivation therapy remain hormone-dependent, the use of other hormonal therapies has been the preferred treatment for the majority of these patients. Besides inhibitors of adrenal steroidogenesis, other novel hormonal approaches are currently under investigation to avoid the effect of the activated androgenic receptor on the tumor cell. In recent years there has been an important development of immunotherapy, which has demonstrated to increase survival in CRPC oligosymptomatic patients. First and second line chemotherapy in CRPC are associated with an increase in overall survival, but they are usually recommended for patients with metastases. Until the results of ongoing trials are available, the type and timing of the treatment for patients with CRPC and biochemical recurrence should be individualized(AU)

Efectividad de la intervención educativa en cuidadores de pacientes dependientes en diálisis y valoración de la carga / The effectiveness of educational intervention in carers of patients in dialysis and evaluation of the load

Los cambios demográficos y el envejecimiento paulatino dela población con insuficiencia renal crónica en tratamiento renal sustitutivo, así como las múltiples patologías asociadas determinan una población muy dependiente de un cuidador. Por todo esto, evaluamos la carga y grado de conocimientos del cuidador principal de los pacientes “dependientes” en tratamiento renal sustitutivo del Complexo Hospitalario de Ourense. Con los resultados obtenidos realizamos una intervención educativa, valorando posteriormente su efectividad. Se determinó que pacientes son dependientes en su tratamiento y autocuidados y se realizó un estudio de sus cuidadores. Se aplicó la escala sobre carga del cuidador de Zarity Zarit y la escala sobre conocimientos del cuidador principal, antes y después de la intervención educativa. En nuestra población el 24,5 % de los pacientes en HD y el 33,3 % en DP son dependientes de un cuidador. Los cuidadores no percibían sobrecarga, siendo el grado similar en ambos tipos de diálisis (hospitalaria vs domiciliaria) y además esta percepción disminuía con el tiempo como cuidador. El grado de conocimientos del cuidador aumentó significativamente tras la intervención educativa. Es importante dar una información adecuada al inicio del tratamiento y continuarla a lo largo del mismo, ya que por sí solos los cuidadores no aumentan el nivel de conocimientos

Good education improves quality of life; the demographic changes and the gradual ageing of the population with chronicrenal insufficiency in substitutive renal treatment, and the many associated pathologies determine a populationthat is highly dependent on carers. We therefore evaluate the load and knowledge of the main carers of “dependent “patients in substitutive renal treatment in the Ourense Hospital Complex. With the results, we perform an educational intervention and follow up by evaluating its effectiveness. It is determined which patients are dependent in their treatment and those who look after themselves, and a study is made of the carers. The Zarit and Zarit scale is applied to the load of the carer and the knowledge of the main care before and after the education. In our population, 24.5 % of the patients in HD and 33.3% in DP are dependent on a carer. The carers perceived no overloading, and the load was similar in both types of dialysis (hospital v home), this perception also falling with their time as carers. The carers’ knowledge increases significantly following the intervention; suitable information must be given at the beginning of the treatment, and must be continued throughout, as the carers do not increase their knowledge without help

Efectividad de la talidomida y la dexametasona en el tratamiento del mieloma múltiple resistente al tratamiento: estudio retrospectivo de 36 casos consecutivos / Effectivity of thalidomide and dexamethasone for the treatment of refractory multiple myeloma: a retrospective study of 36 consecutive cases

Fundamento y objetivo: El mieloma múltiple (MM) es una neoplasia de células plasmáticas que se caracteriza por la presencia de una proteína monoclonal en suero u orina. La talidomida es un fármaco eficaz en el tratamiento de segunda línea de esta enfermedad. Pacientes y método: Hemos realizado un estudio retrospectivo de una serie de 36 casos consecutivos con MM pertinaz a los que hemos tratado con talidomida y dexametasona en segunda línea, con el objetivo de analizar la tasa de respuesta (objetivo primario), la supervivencia libre de progresión (SLP) y toxicidad (objetivos secundarios). Resultados: En nuestro estudio hemos encontrado una tasa de respuesta total del 55,6%, una mediana de SLP de 12,6 meses (intervalo de confianza del 95%, 4-21 meses). La SLP a los 6, 12 y 18 meses fue del 61,11, el 50 y el 22,22% respectivamente. El 30,6% de los pacientes presentaron neuropatía; el 11,11%, erupción cutánea y el 5,55%, enfermedad tromboembólica. Conclusiones: La combinación de talidomida y dexametasona es un tratamiento efectivo y seguro en segunda línea para pacientes con MM resistente al tratamiento, con una toxicidad manejable

Background and objective: Multiple myeloma (MM) is a plasm-cell neoplasm characterized by a monoclonal protein in the serum or urine. Thalidomide is effective as second line treatment. Patients and method: We performed a retrospective study of 36 consecutive patients with refractory MM treated with thalidomide and dexamethasone as second line therapy, with the objective of analyzing the rate of response (primary end point), progression-free survival (PFS) and toxicity profiles (second end points). Results: In our study the overall response rate was 55.6%, with a median of PFS of 12.6 months (95% confidence interval: 4-21 months). PFS at 6, 12 and 18 months was 61.11%, 50% and 22.22% respectively. 30.6% of the patients had neuropathy, 11.11% had rash and 5.55% had deep vein thrombosis. Conclusions: The combination of thalidomide and dexamethasone is an effective and safe second line treatment for refractory MM, with a manageable toxicity