Systematic Review of Light-Based Treatments for Hidradenitis Suppurativa. / Revisión sistemática de las terapias con luz en el tratamiento de la hidradenitis supurativa.

Treatment options for hidradenitis suppurativa include light-based therapy. This systematic review aimed to update our understanding of the efficacy, effectiveness and safety of these treatments for hidradenitis suppurativa by evaluating the literature published since the 2015 Cochrane review on this topic. We conducted an electronic search of the following databases: MEDLINE, EMBASE, University of York Centre for Reviews and Dissemination database, Cochrane Database of Systematic Reviews, Cochrane Skin Group Specialised Skin Register, University of Nottingham's Centre of Evidence Based Dermatology database, and TESEO. The systematic review included 6 case series, 3 systematic reviews, and 2 clinical trials on the use of conventional and intralesional photodynamic therapy, intense pulsed light therapy, and Nd:YAG, carbon dioxide, and diode laser therapy for hidradenitis suppurative in 248 patients.

Childhood trauma. Now and in the new millennium.

Given the magnitude of childhood injuries that occur yearly in the United States, physicians need integrated echelons of care that include regional pediatric trauma centers, trauma centers with pediatric commitment, and EDs appropriate for children. Head injury is the most significant cause of morbidity and mortality among children, but physicians are far from effectively evaluating the dynamics of cerebral metabolism and oxygen delivery in the acute resuscitation of injured children. Critically injured children must be kept normothermic, and attention to the signs of hypovolemic shock must be monitored. Secondary brain ischemia frequently occurs because the details of resuscitation are not carefully monitored. A "leader" must be designated, and this should be someone experienced in childhood trauma. The younger the child and the more severe the injury, the more important is the notion of "experience." The ultimate goal, now and in the new millennium, should not be who, where, or when to administer care to critically ill or injured children but rather the quality of the treatment of these children.

[Electrocardiographic changes in hypoglycemia]. / Alteraciones electrocardiográficas en la hipoglucemia.

Several electrocardiographic anomalies have been described in association with hypoglycaemia. We report the case of a 70-year-old woman with hypoglycaemic coma whose electrocardiogram showed significant conduction anomalies, including atrioventricular block and intraventricular conduction disturbances, and repolarization abnormalities. These electrocardiographic changes disappeared after intravenous glucose administration.

[Clinical diagnostic of brain death and transcranial Doppler, looking for middle cerebral arteries and intracranial vertebral arteries. Agreement with scintigraphic techniques]. / Diagnóstico clínico de muerte encefálica y empleo del Doppler transcraneal, con ecografía de las arterias cerebrales medias y el segmento intracraneal de las arterias vertebrales. Concordancia con los hallazgos de la gammagrafía cerebral.

INTRODUCTION: The Real Ordinance 2070/1999 meant an important modification in the legislation, when including transcranial Doppler (TCD) in explorations to confirm the clinical diagnosis of brain death (BD). Habitually for their employment in the diagnosis of BD, we look for blood flow signal from the middle cerebral arteries (MCA) and the basilar artery (BA). OBJECTIVES: To check the effectiveness of the TCD like test of BD, looking for both middle cerebral arteries (MCA) and both intracranial vertebral arteries (VA), instead of the BA, and taking as Gold Standard cerebral scintigraphic techniques. PATIENTS AND METHODS: . We present 25 patients diagnosed clinically with BD; on these TCD was carried out to confirm BD. Later on we proceeded to carry out cerebral scintigraphic techniques in all these cases. As statistical tool the test of c2 is used with confidence interval of 95%. RESULTS: In 24 of the 25 cases, the TCD was effective in confirming the diagnosis of BD. In the remaining patient, a false positive result was obtained, since the TCD didn't reveal flow in the infratentorial compartment, as contrary to the cerebral scintigraphic techniques which showed the presence of residual flow at this level; this residual flow disappeared in 36 hours. This patient was hemodynamically unstable during TCD exploration. CONCLUSIONS: In our results the TCD obtains a reliability of 100% when confirming the absence of blood flow in the supratentorial compartment; nevertheless the false positive result obtained at the infratentorial level, warns us to be cautious in accepting the flow from the VA as a test of absence of flow at the infratentorial compartment, especially in those patients with hemodynamic instability.

Arabinoxylan-oligosaccharides (AXOS) affect the protein/carbohydrate fermentation balance and microbial population dynamics of the Simulator of Human Intestinal Microbial Ecosystem.

Arabinoxylan-oligosaccharides (AXOS) are a recently newly discovered class of candidate prebiotics as - depending on their structure - they are fermented in different regions of gastrointestinal tract. This can have an impact on the protein/carbohydrate fermentation balance in the large intestine and, thus, affect the generation of potentially toxic metabolites in the colon originating from proteolytic activity. In this study, we screened different AXOS preparations for their impact on the in vitro intestinal fermentation activity and microbial community structure. Short-term fermentation experiments with AXOS with an average degree of polymerization (avDP) of 29 allowed part of the oligosaccharides to reach the distal colon, and decreased the concentration of proteolytic markers, whereas AXOS with lower avDP were primarily fermented in the proximal colon. Additionally, prolonged supplementation of AXOS with avDP 29 to the Simulator of Human Intestinal Microbial Ecosystem (SHIME) reactor decreased levels of the toxic proteolytic markers phenol and p-cresol in the two distal colon compartments and increased concentrations of beneficial short-chain fatty acids (SCFA) in all colon vessels (25-48%). Denaturant gradient gel electrophoresis (DGGE) analysis indicated that AXOS supplementation only slightly modified the total microbial community, implying that the observed effects on fermentation markers are mainly caused by changes in fermentation activity. Finally, specific quantitative PCR (qPCR) analysis showed that AXOS supplementation significantly increased the amount of health-promoting lactobacilli as well as of Bacteroides-Prevotella and Clostridium coccoides-Eubacterium rectale groups. These data allow concluding that AXOS are promising candidates to modulate the microbial metabolism in the distal colon.

Emergencias extrahospitalarias: el paciente suicida / Out-of-hospital emergencies: the suicidal patient

Introducción: La conducta suicida ha existido desde que la humanidad existe, sin embargo, la concepción positiva o negativa del mismoha cambiado a través de las diferentes culturas. En la actualidad, supone un grave problema de salud pública, y se estudia desde diferentesperspectivas y áreas de conocimiento, tratando de dar una visión global para poder entender este fenómeno tan interesante, apasionante y, en ciertos momentos desconcertante. Objetivo: Por tanto, el objetivo del presente estudio es analizar el perfil de las personas que cometen un acto suicida en la ciudad de Madrid y que son atendidos en el área de la emergencia extrahospitalaria. Método: Estudio observacional,descriptivo y retrospectivo, encuadrado en SAMUR-Protección Civil durante el año 2008, analizando todos los casos atendidos de ideación,tentativa y suicidio consumado donde han intervenido un Soporte Vital Avanzado y la Unidad de Asistencia Psicológica. Se ha analizado una muestra de 96 pacientes suicidas, donde el 48,4% fueron tentativas de suicidio, seguidos de un 44,2% de suicidios consumados y un 7,4% de ideación autolítica, atendidos principalmente en los meses de marzo y mayo, turno de mañana - tarde, y en el distrito de Puente de Vallecas, intervenciones demandadas desde Madrid 112 en su mayor porcentaje. Resultados: Se establece un perfil de paciente suicida como varón, de 25-35 años, español, soltero, con patología psiquiátrica en tratamiento, sin tentativas previas, que había verbalizado sus intenciones autolíticas, teniendo como factor desencadenante la propia enfermedad física o psíquica, que elige como método autolítico la defenestración sin presencia de otras personas, al cuál se le traslada al Hospital y presenta como diagnóstico principal TCE, trauma o politraumatismo. (AU)

Background: Suicidal behavior has existed since mankind exists, however, positive or negative view of it has changed through different cultures. At present, poses a significant public health problem, and studied from different perspectives and areas of expertise, trying to give anoverview to understand this phenomenon so interesting, exciting and at times bewildering. Therefore, the objective of this study is to analyze the profile of people who commit a suicide in the city of Madrid and are treated in the outpatient emergency area. Methods: Observational,descriptive and retrospective study, framed in SAMUR-Civil Protection in 2008, analyzing all cases seen ideation, suicide attempt, whichhave involved an Advanced Life Support and Counselling Unit. We analyzed a sample of 96 suicidal patients, where 48.4% were attempted suicide, followed by 44.2% of suicides and suicidal ideation 7.4%, seen mainly in the months of March and May, morning session-afternoon, and in the district of Puente de Vallecas, intervention from Madrid 112 defendants in the highest percentage. Results: Establishing a patient profile suicide as male, 25-35 years, Spanish, single, with psychiatric disorders in treatment, but previous attempts, he had verbalized his intentions autolytic, taking as a trigger for the physical or mental illness itself, which chooses defenestration as autolytic method without thepresence of others, to which he was transferred to the Hospital and has a diagnosis of TBI, trauma or polytrauma. Conclusions: Knowledgeof the profile of the suicidal patient treated in different areas allows better known, the risk factors of suicidal behavior and may facilitatefuture preventive actions (AU)

Estabilidad emocional y cortisol como factores diferenciadores de la fibromialgia / Emotional stability and cortisol as differentiating factors for fibromyalgia

Este estudio busca un acercamiento al diagnóstico de la fibromialgia desde un modelo psicofisiológico del estrés. En la Introducción justificaremos los principios teóricos en que se basa este trabajo. Las hipótesis planteadas intentarán buscar la diferencia de factores psicológicos y de cortisol entre los grupos control y experimental, así como la correlación entre dichos factores. En el apartado Materiales y métodos nos centramos en los registros de cortisol y de variables de personalidad que realizamos en un grupo de 35 mujeres, 18 con fibromialgia y otras 17 libres de la enfermedad. Los aspectos psicológicos serán recogidos por el test de Personalidad CEP de Pinillos, mientras que el cortisol será medido mediante recolección de saliva. Los resultados, muestran diferencias significativas en los factores psicológicos y fisiológicos de los grupos. En las conclusiones afirmamos que el control emocional y los niveles de cortisol son factores distintivos de esta enfermedad con respecto a un grupo control. Sin embargo, no encontramos una correlación significativa entre control emocional y cortisol pudiendo ser debida a variables extrañas o al escaso número de sujetos de la muestra. Además, los resultados de cortisol suponen una contradicción a estudios previos en los que se observa una reducción de esta hormona en pacientes con fibromialgia, por lo que se recomienda una recogida de cortisol del ciclo diurno para complementar el estudio y solucionar estas disensiones (AU)

This study looks for an approach to the diagnosis of fibromyalgia from a psychophysiological model of stress. In the Introduction chapter, we will justify the theoretical principles in which this work is based on. The hypothesis that we suggest will try to find the difference in psychological factors and cortisol between control and experimental group, as well as the correlation of these two factors. In the instrument and method chapter, we will focus on the cortisol and personality variables were achieved in a group of 35 women, 18 with fibromyalgia and 17 disease free. Pinillos CEP Personality test will collect psychological aspects, whereas salivary cortisol will reflect the hormonal level. The results show differences in emotional control and cortisol levels, so in the conclusions chapter, we affirm that these two factors are specific of this disease with respect to a control group. However, there is not a significant correlation between emotional control and cortisol probably due to extraneous variables or the small number of subjects in the sample. Moreover, the results of cortisol are a contradiction to previous studies in which there was a reduction of this hormone in patients with fibromyalgia, so it is recommended a collection of the diurnal cycle of cortisol to complement the study and solve this disagreement (AU)

Guías de práctica clínica y otros productos basados en la evidencia, en la consulta / Clinical Practice guides and other evidence based products in the clinic

GuíaSalud es un organismo del Sistema Nacional de Salud (SNS) en el que participa el conjunto de comunidades autónomas (CC. AA.), que cuenta con el refrendo del Consejo Interterritorial (CI) y el apoyo del Ministerio de Sanidad y Política Social a través de la Agencia de Calidad del SNS. Desde que da su primeros pasos, a mediados del año 2002, hasta la actualidad, se ha visto inmerso en cambios enmarcados en el Plan de Calidad del SNS, siendo el último, descrito en el Plan de Calidad del año 2007 el que implica un giro importante en objetivos, introduciéndose en la cartera de trabajo el desarrollo de productos basados en la evidencia científica que ayuden a los profesionales sanitarios en la toma de decisiones. Esto implica un cambio en la estructura organizativa de dirección y gestión de GuíaSalud, dedicación de recursos dirigidos a fortalecer el desarrollo de guías de práctica clínica (GPC) en nuestro país, y a abrir nuevas líneas de trabajo encaminadas a enriquecer la oferta de productos a los profesionales sanitarios, como es el caso para las preguntas clínicas. En esta estrategia se cuenta con las personas que integran el Comité Científico de GuíaSalud, su Consejo Ejecutivo (CE), y aquellos profesionales sanitarios interesados en una metodología de trabajo sistemática y explícita y que constituyen la red de colaboración de GuíaSalud. Desde la Secretaría de GuíaSalud se cuenta con un equipo de profesionales conocedores de la metodología de trabajo adecuada y una web 2.0 dirigida a interaccionar con los profesionales sanitarios (AU)

GuíaSalud is a National Health System (NHS) agency, which includes all the Autonomous Communities (CCAA), and has the endorsement of the inter-territorial council (IC) which is supported by the Ministry of Health and Social Policy through the NHS Quality Agency. Since its first steps, in mid-2002 until now, it has been immersed in framework changes within the quality of the NHS Plan. The latter being described in the quality plan of 2007, which involves important changes in the objectives, introducing into the work portfo lio the development of products, based on scientific evidence to assist health professionals in decision-making. This involves changes in the organizational structure of leadership and management of GuíaSalud, dedication of resources aimed at strengthening the development of clinical practice guidelines (CPG) in our country, and open new lines of work aimed at enrichment the offer of products to the health professionals, as is the case for clinical questions. This strategy includes professionals who are part of GuíaSalud’ s Scientific Committee, Executive Council (EC), and other health professionals interested in working with a systematic and explicit methodology; and are part of the GuíaSalud collaborative network. The GuíaSalud department has a team of professionals who know about the appropriate methodology and a web 2.0 designed to interact with health professionals (AU)

Insulin-like growth factor I, insulin-like growth factor binding proteins, and growth hormone binding protein in Spanish premature and full-term newborns.

The normal values of insulin-like growth factor I (IGF-I), IGF-binding proteins 1 and 3 (IGFBP-1 and IGFBP-3), and the high-affinity growth hormone binding protein (GHBP) are not well established in large series of healthy fullterm newborns. We report the normative data for IGF-I, IGFBP-I, IGFBP-3, and GHBP in 271 normal Spanish full-term newborns, born between 37 and 42 weeks of gestation, and compare these results with the same parameters studied in 39 premature infants. Furthermore, we report the relationship between results found in the normal full-term newborns and those of 252 healthy prepubertal (Tanner stage I) Spanish children. Serum GHBP, IGF-I, and IGFBP-3 levels are very low in the premature infant and show a significant increase in full-term newborns, and continue to decline during childhood (p < 0.001; analysis of variance). A positive correlation between GHBP, IGF-I, and IGFBP-3 versus gestational age was observed. In contrast, we found a negative correlation between IGFBP-I and gestational age. There is a direct relationship between the ponderal index and IGF-I and IGFBP-3. When the group of premature newborns was divided into infants born before or after 32 weeks of gestation, we found higher levels of IGF-I and IGFBP-3 (p < 0.01 and p < 0.05, respectively, by Student's test) in the group with the higher gestational age; however, the IGFBP-I level was lower in this group (p < 0.001 by Student's t test), with no differences seen in serum GHBP concentrations. The presence of IGFBPs in the premature infant suggests that they are important modulators of IGF-I action during fetal growth and development.

[Intrahospital transportation of critically ill children]. / Traslado intrahospitalario del niño críticamente enfermo.

The intrahospital transport of a critically ill child is always a risky procedure. While it is being done, some complications which can worsen their initial situation may appear, so the benefits that this transport can provide must outweigh the possible risks. Preparing the patient and succeeding in performing a safe transport need the use of the proper equipment and human resources. Its degree of complexity and preparation must be proportional to the situation of instability of the patient and to the probability of increasing such instability, which implies performing a careful evaluation of the child and its real and potential needs previously. We also state some general ideas about the way of preparing and performing this kind of intrahospital transport in its different stages.

Estudio de las Bajas Temporales para el Servicio por motivos psicológicos: Mejoras en la detección de psicopatología y simulación de trastorno mental en las Fuerzas Amadas / Malingering in Mental Disorder in Sick Leaves

Antecedentes y Objetivos. Existen numerosas investigaciones sobre simulación de trastorno mental en diversos contextos clínico-forenses relacionados con distintos y variados trastornos. Sin embargo y a pesar de la prevalencia que puede tener el trastorno mental en el contexto de las bajas laborales no existen tantos estudios que afronten esta situación administrativa relacionándola con la simulación. Esta investigación aborda la simulación de trastorno mental en las Bajas Temporales para el Servicio en un entorno militar. Material y Métodos. El trabajo se enmarca dentro del ámbito forense médico militar pericial. Desde un diseño de análogos se compararán las respuestas de dos grupos de sujetos al realizar el Inventario de Evaluación de la Personalidad (Personality Assessment Inventory – PAI) de L. Morey. La muestra se compone de 91 sujetos no expertos ni en psicopatología, ni en pruebas diagnósticas. 37 de ellos estuvieron en la condición experimental A (análogos o simuladores) y 54 en la condición B (de baja médica por psiquiatría, el 47,9% diagnosticados de Trastorno Adaptativo, el 26% de Depresión, 21,8% de Ansiedad y 4,3% de otros trastornos mentales). Ambas condiciones serán comparadas en los resultados obtenidos en las escalas clínicas, de validez y simulación del PAI. Para analizar si existen diferencias en dichas escalas en función de la condición experimental asignada se realizó un diseño unifactorial intergrupo y una comparación de medias mediante T de Student con el programa informático SPSS v.15. Los datos de los participantes fueron recogidos en el primer semestre de 2009. Resultados. Se encontraron diferencias en todas las variables al responder al PAI excepto en las variables Depresión (DEP) y Ansiedad (ANX). Las diferencias encontradas en las escalas de simulación y psicopatología serán analizadas. Conclusiones. El PAI se ha mostrado como un instrumento válido en la detección de simulación en el ámbito de las FAS. La escala Impresión Negativa (NIM) fue la más eficaz en la diferenciación de simuladores y grupo clínico. Sin embargo, la escala Simulación (MAL) no clasificó al grupo de simuladores como se esperaba. Los resultados encontrados en las escalas clínicas son congruentes con los diagnósticos del grupo de baja. Los síntomas elegidos por el grupo de simuladores para dar mala imagen fueron, sobretodo, los de las escalas Depresión (DEP), Paranoia (PAR) y Problemas con las Drogas (DRG) (AU)

Background/ Previous and Object: There are many investigations about malingering in different clinical-forensic context. However and in spite of mental disorder in sick leaves prevalence there aren´t that many studies about this topic being joined with malingering. This study is about mental disorder in sick leaves in a military context. Material and Method:. This work is framed within the military medical forensic expert. It has been compared two groups responses in Personality Assessment Inventory (PAI). The sample are 91 participants, in A condition were 37 naïve malingeres and in B condition 54 people with designated disorders (47,9% Adaptative Disorder, 26% Depression, 21,8% Anxiety Disorder and 4,3% others). Both conditions will be compared in clinical, validity and malingering scales of the PAI. To know if there are differences in those scales in both conditions a univariate design intergroup has done and a T means comparison with SPSS v. 15. Data was kept in 2009 first semester. Results: Differences in most of the variables but non on Depression (DEP) neigther Anxiety (ANX) were found. Differences in malingering and clinical scales will be analyzed. Conclusions: PAI has been shown to be a valuable tool for the detection of simulation in the field of Armed Forces. Negative Impresion scale (NIM) was the most effective one scale to differentiate between groups. However Malingering scale (MAL) didn´t work as expected. Results are consistent with designated disorders for clinical sample. Symptoms choosed by malingering group were those from Depression (DEP), Paranoia (PAR) and Drug Problems (DRG) scales (AU)

El síndrome de burnout / Burnout syndrome

Cada día son más los datos que avalan la prevalencia del burnout en nuestra sociedad; el adecuado conocimiento de las estrechas y complejas relaciones entre estrés laboral y burnout puede ayudar a prevenir y tratar el problema, lo que repercutirá beneficiosamente sobre las personas y su ejercicio profesional en cualquier ambiente laboral (AU)

Encuesta epidemiológica sobre el sueño en la población juvenil / Epidemiologic survey about sleep habits and disorders among young people

Aplicando un cuestionario auto-administrado, se realizó una encuesta epidemiológica sobre hábitos y trastornos de sueño en una muestra de 864 adultos jóvenes, de 19-25 años de edad, al incorporarse al Servicio Militar. Los resultados más significativos de la encuesta fueron: retraso en la hora de acostarse y levantarse los días festivos, y la prolongación esos días del tiempo en cama. La latencia del sueño fue más alta que la comúnmente descrita en la literatura, ya que un 36,7 de los sujetos refirieron tardar más de 20 minutos en conciliar el sueño. Un 42,1 por ciento de los sujetos dijeron que tenían episodios de hipersomnolencia diurna. Respecto al ronquido, un 29,4 por ciento de los sujetos afirmaban ser roncadores habituales. Un 7 por ciento de los encuestados refirió haber tomado pastillas para dormir en alguna ocasión, y un 1,7 por ciento continuaba tomándolas. Un 63,1 por ciento de los sujetos manifestó que retrasaba o adaptaba la hora de acostarse, dependiendo de los programas de televisión (AU)