Interobserver reliability of classifying shoulder calcific tendinopathy on plain radiography and ultrasound.

INTRODUCTION: Shoulder calcific tendinopathy is a frequent cause of shoulder pain. Diagnosis is usually based on ultrasound (US) and/or X-ray. US is considered an inherently operator-dependent imaging modality and, interobserver variability has previously been described by experts in the musculoskeletal US. The main objective of this study is to assess the interobserver agreement for shoulder calcific tendinopathy attending to the size, type, and location of calcium analyzed in plain film and ultrasound among trained musculoskeletal radiologists. MATERIAL AND METHODS: From June 2018 to May 2019, we conducted a prospective study. Patients diagnosed with shoulder pain related to calcific tendinopathy were included. Two different experienced musculoskeletal radiologists evaluated independently the plain film and the US. RESULTS: Forty patients, with a mean age of 54.6 years, were included. Cohen's kappa coefficient of 0.721 and 0.761 was obtained for the type of calcium encountered in plain film and the US, respectively. The location of calcification obtained a coefficient of 0.927 and 0.760 in plain film and US, respectively. The size of the calcification presented an intraclass correlation coefficient (ICC) of 0.891 and 0.86 in plain film and US respectively. No statistically significant differences were found in either measurement. CONCLUSION: This study shows very good interobserver reliability of type and size measurement (plain film and US) of shoulder calcifying tendinopathy in experienced musculoskeletal radiologists.

Análisis de nuestra experiencia en el diagnóstico y tratamiento de la hernia obturatriz en un hospital de tercer nivel / Analysis of our experience in the diagnosis and treatment of obturator hernia in a third level hospital

La patología herniaria supone un porcentaje importante de las intervenciones quirúrgicas urgentes. La hernia obturatriz es una entidad poco frecuente, presentándose generalmente como un cuadro de oclusión intestinal agudo en mujeres adultas. El objetivo del estudio es analizar la experiencia en un hospital de tercer nivel en el diagnóstico y tratamiento de la hernia obturatriz, así como detectar aquellos signos que permitan un diagnóstico precoz. La técnica de imagen de elección para su diagnóstico es la tomografía computarizada. Se trata de un estudio observacional prospectivo, en el que se incluyeron pacientes intervenidos de forma urgente por hernia obturatriz entre los años 2000 y 2016. Para el registro de la morbilidad postoperatoria se empleó la clasificación de Clavien-Dindo. Se identificaron doce pacientes con clínica de obstrucción intestinal secundaria a hernia obturatriz. Todos ellos fueron intervenidos de forma urgente, realizándose laparotomía media urgente en el 59%, laparotomía media infraumbilical en el 33% y abordaje por vía inguinal posterior en un solo paciente (8%). En ocho pacientes (67%) fue necesario realizar una resección intestinal por isquemia intestinal. La técnica quirúrgica empleada fue la reparación mediante malla de polipropileno en seis pacientes (50%), mediante tapón en dos (17%) y cierre con puntos sueltos en cuatro (33%). Cuatro de ellos presentaron complicaciones postoperatorias, registrando un único exitus secundario a perforación por sufrimiento intestinal. Es prioritario establecer un diagnóstico precoz y tratamiento quirúrgico urgente para reducir la morbimortalidad asociada a la hernia obturatriz

Hernia pathology accounts for a large percentage of urgent surgical interventions. Obturator hernia is rare, usually presenting as a picture of acute intestinal occlusion. The aim of the study is to analyze the experience in a third level hospital in the diagnosis and treatment of obturator hernia, as well as to detect those signs that allow an early diagnosis. This is a prospective observational study, which included patients operated on urgently for obturator hernia between 2000 and 2016. For the registration of postoperative morbidity, the Clavien-Dindo classification was used. We identified twelve patients with intestinal obstruction secondary to obturator hernia. All of them were operated on urgently. Urgent midline laparotomy was carried out on 59% of them, infraumbilical laparotomy on 33%, and a posterior inguinal approach was realized on only one patient (8%). In eight patients (67%) it was necessary to perform intestinal resection. Repair was performed by polypropylene mesh in six patients (50%), by plugging in two (17%) and closing with loose stitches in four patients (33%). Four of them presented postoperative complications, recording a single exitus secondary to perforation due to intestinal suffering. Obturator hernia is a rare entity that develops mostly as an occlusive condition in elderly women. The imaging technique of choice for diagnosis is computed tomography. Establishing an early diagnosis and urgent surgical treatment is a priority to reduce associated morbidity and mortality

Employment in a cohort of cancer patients in Spain. A predictive model of working outcomes

INTRODUCTION: Cancer patients can have problems remaining in employment but the importance of this issue has until now received little attention in Spain. PATIENTS AND METHODS: The study included 347 consecutive cancer patients who were employed at diagnosis. Diagnosis had been confirmed at least 6 months before the interview. Participants completed a questionnaire concerning cancer-related symptoms and work-related factors and clinical details were obtained from their medical records. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. RESULTS: Eighty-five percent of patients were unable to work after diagnosis, but 59% returned to work at the end of treatment. Gender, age, type of worker and type of treatment were independently associated with the ability to work after diagnosis. At the end of treatment these factors were age, education, tumour stage, overall response to the therapy, associated co-morbidity and sequelae of the disease or its treatment. Twenty-one percent noticed changes in their relationship with co-workers and managers, usually in the sense that they tried to be helpful. In a multivariate logistic regression analysis, the strongest predictors for remaining in employment were age, overall response and sequelae of the disease or its treatment. CONCLUSIONS: Cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment, rather than to discrimination by employers or colleagues. Prediction of working outcomes is possible to recommend interventions (AU)

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Cuidados al final de la vida en una unidad de cuidados intensivos pediátricos: evaluación por parte del personal y de los padres / End-of-life care in a Spanish Pediatric Intensive Care Unit: staff and Parental Evaluation

Objetivos: Evaluar los cuidados al final de la vida en una unidad de cuidados intensivos pediátricos (UCIP). Métodos: Estudio retrospectivo desarrollado en una UCIP. Los sujetos fueron 41 trabajadores de la UCIP y los padres de 26 niños fallecidos entre 2001 y 2005. Se diseñó un cuestionario para evaluar los cuidados al final de la vida proporcionados en este período. Resultados: La edad inferior a 1 año y las enfermedades crónicas o congénitas son las variables que se correlacionaron con una mayor percepción de incoherencia en la información. Cerca del 38 % de los padres estuvieron junto a sus hijos en el momento del fallecimiento; el 64 % de ellos consideran estar presentes algo positivo, y el 13 %, algo negativo. El 40 % del personal declaró que es positivo para los padres estar al lado de sus hijos en el momento del fallecimiento, y el 52 % no sabía si era positivo o negativo. El 73 % del personal, pero sólo el 29 % de los padres, desearía apoyo psicológico profesional para los padres. El 20 % de los niños fallecieron tras la retirada del soporte vital. Los factores más importantes para esta decisión fueron la posibilidad de supervivencia y la calidad de vida. La mayoría de los sanitarios expresaron que, a menudo, esta decisión debería haber sido tomada antes. Conclusiones: El análisis del personal subraya la importancia del cómo las noticias son comunicadas, del momento de retirada del soporte vital y la necesidad del apoyo psicológico. Los padres enfatizan más el papel de la familia en la UCIP y durante los últimos momentos (AU)

Objectives: To evaluate end-of-life care in a Paediatric Intensive Care Unit (PICU). Methods: Retrospective study developed in a PICU. Subjects: 41 workers from the PICU and parents of 26 deceased children (from 2001 to 2005). A questionnaire was designed to investigate end-of-life care. Results: An age < 1-year old and a chronic or congenital disease correlated with a perceived lack of consistency in information. Nearly 38 % parents were with their children at the time of death; 64 % of all parents consider this "positive", and 13 % consider it "negative". Forty per cent of staff stated that it is "positive" for parents to be by the side of their child at the time of death, and 52 % do not know. Seventy-three per cent of staff, but only 29 % of parents want further professional psychological support for parents. Twenty per cent of children died following withdrawal of life support. The most important factors for this decision were the possibility of survival and quality of life. The majority (73 %) of caregivers express the view that often, this decision should be taken earlier. Conclusions: Analysis of staff opinions underlines the importance of the way news is communicated, the timing of withdrawal of life support, and the need for psychological support. Parents emphasized the role of the family during time spent in a PICU and during the last moments (AU)

Influencia del antecedente de diabetes mellitus en la gravedad y evolución intrahospitalaria de un infarto cerebral / Influence of previous diagnosis of diabetes mellitus in the stroke severity and in-hospital outcome in acute cerebral infarction

Introducción. Se analiza si el diagnóstico previo de diabetes mellitus (DM) influye en la gravedad al ingreso y en la evolución hospitalaria de los pacientes con infarto cerebral (IC) agudo. Métodos. Estudio observacional durante el período 1998- 2004. Se seleccionan pacientes con IC. Se comparan dos grupos (pacientes con y sin antecedentes de DM) analizándose: antecedentes personales, subtipo etiológico de ictus, gravedad al ingreso (Escala Canadiense [EC] de ictus) complicaciones intrahospitalarias, mortalidad, estancia media y estado funcional al alta (Escala de Rankin modificada [ERm]). Resultados. Se incluyeron 2.213 pacientes con IC agudo; 661 con antecedentes de DM (29,9 %) Éstos tuvieron una mayor edad, mayor frecuencia de hipertensión, dislipemia, cardiopatía isquémica, vasculopatía periférica e IC previo. Los infartos aterotrombóticos y lacunares fueron más frecuentes entre los pacientes con antecedentes de DM. Éstos tuvieron mayor porcentaje de infección urinaria (4,7 frente a 2,6 %; p < 0,05), fracaso multiorgánico (3,3 frente a 1,8 %; p<0,05), ictus en evolución (6,1 frente a 3,4%; p<0,01), ictus recurrente (3,3 frente a 1,7 %; p < 0,05) y aumento del volumen del infarto (2,6 frente a 1,1%; p<0,05) sin diferencias significativas en gravedad al ingreso, mortalidad, estancia media y estado funcional al alta. El antecedente de DM estuvo asociado a un mayor riesgo de complicaciones intrahospitalarias (odds ratio: 1,377; intervalo de confianza del 95%: 1,053-1,799). Conclusiones. Los pacientes con antecedentes de DM no presentaron mayor gravedad al ingreso, pero sí mayor riesgo de desarrollo de complicaciones (AU)

Introduction. To analyze if previous diagnosis of diabetes influences stroke severity and in-hospital outcome in acute cerebral infarction (CI) patients. Methods. Observational study between 1998–2004 with inclusion of consecutive patients with CI. Risk factors, stroke subtype, severity on admission (Canadian Stroke Scale [CSS]), in-hospital complications, mortality, length of stay and stroke outcome (modified Rankin Scale [mRS]) in CI patients with and without previous diagnosis of diabetes were compared. Results. A total of 2,213 consecutive acute stroke patients; 661 with previous history of diabetes (29,9%) were included. These patients were older, had more rate of hypertension, dyslipidemia, coronary arterial disease, peripheral vascular disease and previous stroke than non-diabetic patients. Atherotrombotic and lacunar infarction were more frequent in diabetic patients. They also had more in-hospital complications as urinary tract infection (4.7 % vs 2.6 %; p < 0.05), multiple organ dysfunction syndrome (3.3% vs 1.8%; p<0.05), deteriorating stroke (6.1 % vs 3.4 %; p < 0.01), recurrent stroke (3.3% vs 1.7%; p<0.05) and increase of infarction volume (2.6 % vs 1.1%; p<0.05), with no differences in stroke severity at admission, mortality, length of in-hospital stay and stroke outcome. Previous history of diabetes was independently associated with in-hospital complications (OR: 1.377; CI 95%: 1.053-1.799). Conclusions. Previous diagnosis of diabetes is not associated by itself to higher stroke severity on admission although a greater risk of in-hospital complications is found (AU)

Alcohol y emigración: los problemas de medición en la investigación sobre el consumo de alcohol entre inmigrantes marroquíes y turcos / Alcohol and migrations: problems in the measurement of alcohol consumption in Turkish and Moroccan immigrants

El Islám prohíbe el consumo de alcohol, por lo que uno de los factores determinantes del consumo de alcohol entre los ciudadanos de origen turco y marroquí que viven en Holanda es el grado en el que viven conforme con las normas del Islám. Esto último depende en parte de su historia migratoria, su bagaje subcultural y su grado de integración en la sociedad holandesa. En este capítulo resumen 24 estudios holandeses que tratan el consumo de alcohol entre turcos y marroquíes y discutimos los problemas metodológicos y conceptuales que conllevan este tipo de estudios. Estas investigaciones se enfrentan con el problema de contactar con turcos y marroquíes, el problema de la validez de las respuestas obtenidas (el Islám destaca la importancia de valores tales como el honor y el respeto que pueden llevar a que los sujetos subestimen su consumo de alcohol), así como problemas de idioma. Además del problema del reducido tamaño de las muestras, se discuten los distintos métodos de investigación utilizados en los distintos estudios, y la conceptualización de “origen étnico”, que influyen en la fiabilidad y validez de los resultados. A pesar de todo se puede concluir que el consumo de alcohol entre los ciudadanos de origen turco y marroquí residiendo en los Países Bajos consumen menos alcohol que los holandeses; que los turcos consumen más alcohol que los marroquíes; que tanto entre los turcos como entre los marroquíes los hombres beben más que las mujeres, y los jóvenes más que los mayores (AU)

Since most Turks and Moroccans living in The Netherlands are Muslim, and the Islamic religion prescribes abstinence of alcohol, the main determinant of alcohol use seems to be the degree to which live up to Islamic rules. This is linked to questions such as the migration history, the sub-cultural background and the degree of integration into the Dutch society. The present article also presents a review of 24 Dutch studies on alcohol use among Turkish and Moroccan migrants and discusses the methodological and conceptual problems that accompany these studies. According to these literature the data are affected by a low reachability of Turks and Moroccans (often resulting in the participation of a selective, non-representative group), unreliable answering tendencies (the Islamic orientation and cultural values of honor and respect may result in underreporting of alcohol use) and language problems. The authors argue that, although several conceptual and methodological difficulties accompany alcohol research among Turkish and Moroccan inhabitants of The Netherlands, the following tendencies seem evident: Turks and Moroccans drink less alcohol than Dutch inhabitants do; alcohol use is higher among Turks than among Moroccans; in the Turkish as well as the Moroccan population, men tend to drink more alcohol than women do, and younger people tend to drink more than older people do (AU)