Building management and innovation capabilities for global health: a senior executive program.

Accurately approaching the major challenges associated with global health management has become a mandatory key point in the training of medical leaders around the world. The Senior Executive Program in Global Health Innovation Management (SEPGHIM) seeks to provide an answer to the need for innovation and managerial capacity building in Global Health and to address the current detachment between Public Health Organizations and Business Schools. In 2019, SEPGHIM's first edition was led by five prestigious academic institutions on three continents. The first cohort included a total of 27 high-level health professionals and executives from 16 countries with 7-10 years of working experience who participated during the 11 months of the course. The program sought to fill an often-found knowledge gap among health professionals in terms of health innovation, leadership, and management. SEPGHIM relied on multiple pedagogical methods conveyed through a robust theoretical and applied syllabus that included case studies, simulations, guest speakers, debates, site visits, and an executive challenge. The program achieved various results. First, it recruited high-level health professionals that ensured diversity of backgrounds, allowing an exchange of experiences and different ways of addressing global health challenges. Second, it created a network of health professionals for possible future collaborations that can anticipate new trends and opportunities in global health and work together with stakeholders from other sectors. This networking was one of the most highly rated benefits by the students. Finally, the participants expressed great eagerness to recommend the program (4.9 out of 5) to other decision-makers and leaders in the global health field. These results provide positive insights regarding the value of such a training program for senior health professionals.

Fístula arteriovenosa para hemodiálisis en receptores de trasplante renal. Su repercusión clínica, humoral y cardiovascular / Arteriovenous fistula for hemodialysis in renal transplant recipients. Clinical, humoral and cardiovascular repercussions

Introducción: La fístula arteriovenosa para hemodiálisis repercute negativamente sobre la hemodinamia, la morfología y las funciones cardíacas. Objetivo: Determinar la repercusión del cierre del acceso vascular sobre variables clínicas, humorales, morfológicas y funcionales del corazón derecho en receptores de trasplante renal. Material y Métodos: Estudio cuasi-experimental longitudinal que incluyó 92 pacientes divididos en dos grupos, experimental (n=46): con cierre del acceso vascular, y de comparación (n=46): sin cierre del angioacceso. Se determinaron variables clínicas, de laboratorio, y ecocardiográficas en dos tiempos: inicial y seis meses posteriores. Resultados: La media de edad en ambos grupos fue de 46,87 ±12,04 y 45,50 ±12,47 años respectivamente. Prevaleció el sexo masculino; 26 (56,52 %) y el color de piel blanca; 34 (73,91 %). Las palpitaciones fueron la manifestación clínica más frecuente con mejoría a la segunda observación en el grupo experimental, al igual que las presiones sistólica y diastólica, así como la creatinina sérica; de 108,24 ±24,53 a 100,00 ±22,35 μMol/L (p=0,004). Las variables mensuradas por ecocardiografía mejoraron en el grupo intervenido respecto al de comparación. Las diferencias final-inicial para las presiones sistólica y media de la arteria pulmonar mostraron relaciones muy significativas (p <0,001) para las fístulas localizadas en la muñeca y en el pliegue del codo izquierdos. Conclusiones: Las variables estudiadas mostraron cambios ostensibles en el grupo experimental respecto al de comparación posterior al cierre de la fístula arteriovenosa sin constatar asociación entre su localización y la severidad de la afectación cardíaca.

Introduction: Arteriovenous fistula for hemodialysis has a negative impact on hemodynamics, morphology, and cardiac functions. Objective: To determine the repercussion of vascular access closure on clinical, humoral, morphological and functional variables of the right heart in renal transplant recipients. Material and Methods: Quasi-experimental longitudinal study that included 92 patients divided into two groups: experimental (n=46): with vascular access closure, and comparison (n=46): those who did not have the angioaccess closed. Clinical, laboratory and echocardiographic variables were determined at two points in time: initial and six months later. Results: The mean age in both groups was 46.87 ±12.04 and 45.50 ±12.47 years, respectively. Male sex: 26 (56.52 %), as well as white skin color: 34 (73.91 %), prevailed in the study. Palpitations were the most frequent clinical manifestation with improvement at the second observation in the experimental group, as were systolic and diastolic pressures, as well as serum creatinine: from 108.24 ±24.53 to 100.00 ±22.35 μMol/L (p=0,004). The variables measured by echocardiography improved in the intervention group with respect to the comparison group. The final - initial differences for systolic and mean pulmonary artery pressures showed highly significant relationships (p<0.001) for fistulas located at the left wrist and elbow crease. Conclusions: The variables studied showed ostensible changes in the experimental group with respect to the comparison after closure of the arteriovenous fistula without finding an association between their location and the severity of cardiac involvement.

Food consumption in the Canary Islands: nutritional implications of food imports and local production.

BACKGROUND: The composition of the average diet for the Canary Islands' population has been the subject of concern for the region's authorities and nutrition specialists. In this study, the composition of the average diet in the Canary Islands is estimated. METHOD: The approach is based on secondary data on local production and external trade. The breakdown of the total volume of apparent food consumption into specific product categories marketed to the consumers is achieved by applying hypotheses about losses in the distribution process. The estimation of food intake is obtained by making assumptions about the rates of food wastage in the final stage of consumption. This consumption is expressed not only in terms of edible weight and the market value associated with different food groups according to their local or imported origin, but also in terms of their energy and nutrient content. RESULTS: The results obtained suggest a high-calorie diet, close to three thousand kilocalories per person per day, with an average cost of around eight euros per person per day. Imported products, with a lower average cost per unit of energy, provide most of the carbohydrates and fats. CONCLUSION: This study provides a complementary approach to survey-based evidence and also offers the possibility of evaluating the contributions of local or imported food to the diet.

Angioaccesos para hemodiálisis en el trasplante renal: implicaciones hemodinámicas sobre el corazón izquierdo / Angioaccess for hemodialysis in kidney transplantation: hemodynamic implications for the left heart

Las complicaciones cardiovasculares representan la principal causa de morbilidad y mortalidad en pacientes con enfermedad renal crónica, por lo que el objetivo de este artículo es demostrar la influencia de la permanencia de la fístula arteriovenosa sobre variables eco cardiográficamente mensuradas en el corazón izquierdo. Para ello, se definió un estudio multivariable, longitudinal, prospectivo y controlado de grupos independientes después de una intervención que incluyó 39 pacientes a los que se le cerró el angioacceso (grupo de estudio) y 42 que no fueron expuestos a la cirugía (grupo control). Ambos grupos exhibían trasplante renal funcionante. Los principales resultados surgenal comparar el predominio entre el grupo de estudio con el de control, la edad promedio; 45,6 y 44,1 años, el sexo masculino, 24 (60%) y 23 (53,5%) y el color de la piel blanca; 33 (82,5%) y 32 (74,4%). La etiología de la nefropatía originaria más frecuente fue la nefropatía vascular hipertensiva; 12 (30%) vs 14 (32,6%). Entre las manifestaciones clínicas, en el grupo de estudio se evidenció remisión de las palpitaciones y la disnea de esfuerzo. Respecto a la tensión arterial, para la sistólica oscilaba; de 123 ±13,4 a 120,5 ±9,2 vs de 125,6 ±8,4 a 128 ±8,3 mm Hg (p= 0,000), mientras la diastólica variaba de; 76,8 ±7,5 a 76,3 ±6,2 vs 78,6 ±4,9 a 82,4 ±3,9 mm Hg (p= 0,000). El hematocrito comportaba valores equivalentes; 0,43 ±0,06 y 0,45 ±0,06 vs 0,42 ±0,05 y 0,42 ±0,06 l/l (p= 0,035) y la creatinina sérica mostró descenso en los pacientes intervenidos de; 106,8 ± 26,2 hasta 99,8 ±23,9 µ Mol/l vs 114 ±27,8 a 120,3 ±31 µ Mol/l (p= 0,002). Las variables ecocardiográficas mensuradas comparativamente según la localización de los angioaccesos a nivel del codo izquierdo; diámetro del ventrículo izquierdo: 3,12 ±4,08 vs 1,48 ±3,46 mms (p=0,001), fracción de eyección del ventrículo izquierdo: 2,99 ±5,47 vs -1,98 ±6,23 % (p=0,018) y el volumen telediastólico: -23 ±33,41 vs 10,86 ±36,87 ml (p=0,006). El codo contralateral revelaba; para la fracción de eyección del ventrículo izquierdo: 3,32 ±3,42 vs -2,18 ±4,78 % (p=0,037) y para el gasto cardíaco: -1,29 ±0,88 vs -0,26 ±0,86 l/min (0,020). Las conclusiones demuestran que el cierre del angioacceso a pacientes con trasplante renal funcionante respecto a los no intervenidos, contribuye a la regresión de las alteraciones morfológicas y hemodinámicas constatadas por ecocardiografía transtorácica en el corazón izquierdo a nivel de las diferentes localizaciones de los accesos vasculares.

Cardiovascular complications represent the main cause of morbidity and mortality in patients with chronic renal disease, so the objective of this article is to demonstrate the influence of the patency of the arteriovenous fistula on echocardiographic variables measured in the left heart. For this, a multivariate study, longitudinal, prospective and controlled study of independent groups after an intervention that included 39 patients who had their angioaccess closed (study group) and 42 who were not exposed to surgery (control group). Both groups exhibited functional kidney transplantation. The main results emerge when comparing the prevalence between the study group and the control group, the average age; 45.6 and 44.1 years, the male sex, 24 (60%) and 23 (53.5%) and the white skin color; 33 (82.5%) and 32 (74.4%). The most frequent etiology of the original nephropathy was hypertensive vascular nephropathy; 12 (30%) vs 14 (32.6%). Among the clinical manifestations, remission of palpitations and dyspnea on exertion were evidenced in the study group. With regard to blood pressure, for the systolic it ranged from 123 ±13.4 to 120.5 ±9.2 vs. 125.6 ±8.4 to 128 ±8.3 mmHg (p= 0.000), while the diastolic varied from; 76.8 ±7.5 to 76.3 ±6.2 vs. 78.6 ±4.9 to 82.4 ±3.9 mmHg (p= 0.000). The hematocrit had equivalent values; 0.43 ±0.06 and 0.45 ±0.06 vs 0.42 ±0.05 and 0.42 ±0.06 l/l (p= 0.035) and the serum creatinine showed decrease in the operated patients from; 106.8 ±26.2 to 99.8 ±23.9 µMol/l vs 114 ±27.8 to 120.3 ±31 µMol/l (p= 0.002). The echocardiographic variables measured comparatively according to the location of the angioaccesses at the left elbow level; diameter of the left ventricle: 3.12 ±4.08 vs 1.48 ±3.46 mms (p=0.001), ejection fraction of the left ventricle: 2.99 ±5.47 vs -1.98 ±6.23 % (p=0.018) and the telediasolic volume: -23 ±33.41 vs 10.86 ±36.87 ml (p=0.006). The contralateral elbow revealed; for the left ventricular ejection fraction: 3.32 ±3.42 vs -2.18 ±4.78 % (p=0.037) and for cardiac output: -1.29 ±0.88 vs -0.26 ±0.86 l/min (0.020). The conclusions show that the our study has shown that closing the angioaccess to patients with functioning renal transplants with respect to those not operated, contributes to the regression of morphological and hemodynamic alterations observed by transthoracic echocardiography in the left heart at the different locations of the vascular accesses.

Repercusión hemodinámica del cierre de la fístula arteriovenosa sobre el corazón derecho en trasplantados renales / Hemodynamic impact of arteriovenous fistula closure on the right heart in kidney transplant patients

Introducción: Las complicaciones cardiovasculares constituyen la primera causa de morbilidad y mortalidad en el receptor de trasplante renal. Objetivo: Caracterizar la repercusión de la fístula arteriovenosa sobre variables hemodinámicas del corazón derecho en trasplante renal. Métodos: Estudio prospectivo, longitudinal. Se incluyeron 52 pacientes, evaluados clínica y ecocardiográficamente. Se compararon cinco variables hemodinámicas en el corazón derecho, previos y seis meses posteriores al cierre de la fístula arteriovenosa. Resultados: La edad promedio 46,02 años, 29 masculinos (55,8 por ciento). El diámetro de la aurícula derecha en las fístulas cerradas en la muñeca izquierda 8805; 6 años disminuyó (p=0,044), al igual que en el ventrículo derecho <6 años a nivel del pliegue del codo izquierdo (p=0,004). La presión sistólica de la arteria pulmonar descendió tras el cierre en el codo izquierdo lt;6 años (p=0,002), en las 8805;6 (p=0,05) y en el derecho (p=0,006). La presión media de la arteria pulmonar se redujo en las cerradas en pliegue del codo izquierdo <6 años (p=0,001) y 8805;6 años (p=0,017) al igual que en el derecho (p=0,009). La fracción de eyección del ventrículo derecho se incrementó al cierre en muñeca izquierda ;6 años (p=0,046) y en el codo derecho 8805;6 años (p=0,027). Conclusiones: La permanencia de la fístula arteriovenosa en el receptor de trasplante renal contribuye a la perpetuación y progresión de la disfunción cardiovascular preexistente(AU)

Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in kidney transplant recipients. Objective: To describe the consequence of arteriovenous fistula on hemodynamic variables of the right heart in kidney transplantation. Methods: We conducted a prospective, longitudinal study. Fifty two patients were included, and they were clinically and echocardiographically assessed. Five hemodynamic variables were compared in the right heart, prior to the closure of the arteriovenous fistula and six months after. Results: The average age was 46.02 years, 29 were male (55.8 percent). The diameter decreased in the right atrium in closed fistulas in the left wrist #8805; 6 years (p = 0.044). The same occurred in the right ventricle <6 years at the level of the left elbow crease (p = 0.004). The systolic pressure of the pulmonary artery decreased after closure in the left elbow <6 years (p = 0.002), in ≥6 (p = 0.05) and in the right (p = 0.006). The mean pressure of the pulmonary artery was reduced in those closed in the crease of the left elbow <6 years (p = 0.001) and ≥6 years (p = 0.017) as well as in the right (p = 0.009). The right ventricular ejection fraction increased at closure in the left wrist <6 years (p = 0.046) and in the right elbow ≥6 years (p = 0.027). Conclusions: The permanence of arteriovenous fistula in the kidney transplant recipient contributes to the perpetuation and progression of the pre-existing cardiovascular dysfunction(AU)

Hemoglobina glucosilada como predictor de mortalidad y complicaciones en pacientes con infarto agudo del miocardio con elevación del segmento ST / Glycated hemoglobin as predictor of mortality and complications in patients with acute myocardial infarction with st-segment elevation

Introducción: La hemoglobina glucosilada pudiera convertirse en una herramienta en la estratificación inicial de pacientes infartados según el balance metabólico previo. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada para muerte y complicaciones cardíacas mayores en el período intrahospitalario en pacientes con diagnóstico de infarto agudo del miocardio con elevación del segmento ST. Métodos: Se realizó un estudio observacional analítico de cohorte prospectivo en pacientes atendidos en la Unidad de Cuidados Coronarios del Hospital Universitario Arnaldo Milián Castro entre noviembre de 2018 y marzo de 2019 por presentar diagnóstico de infarto del miocardio agudo con elevación del segmento ST (N=73), de los cuales se seleccionó una muestra de 62 pacientes. Se realizó un análisis de conglomerados de K-medias y se valoró el área bajo la curva ROC de la hemoglobina glucosilada para predecir mortalidad y complicaciones mayores. Resultados: Existieron diferencias estadísticamente significativas entre los diferentes cluster en las variables estado al egreso (p=0,001; V=0,489) y ocurrencia de complicaciones cardíacas mayores (p=0,050; V=0,307). El análisis del estadístico C de la hemoglobina glucosilada demostró su capacidad predictiva para mortalidad tanto en diabéticos (C=0,810; p=0,014) como en no diabéticos (C=0,817; p=0,006), así como para complicaciones cardíacas mayores en diabéticos (C=0,799; p=0,015) y no diabéticos (C=0,683; p=0,052). Se estableció el punto de corte en 7,8 por ciento, por encima del cual la hemoglobina glucosilada constituyó un factor pronóstico de mortalidad y complicaciones cardíacas mayores. Conclusiones: Se determinó que la hemoglobina glucosilada posee capacidad para predecir mortalidad y complicaciones cardíacas mayores en el período intrahospitalario. Su valor por encima del punto de corte constituyó un predictor independiente(AU)

Introduction: Glycated hemoglobin could become a tool in the initial stratification of infarcted patients according to the previous metabolic balance. Objective: To determine the prognostic value of death glycated hemoglobin and major cardiac complications in the in-hospital period in patients diagnosed with acute myocardial infarction with ST-segment elevation. Methods: A prospective cohort analytical observational study was conducted in patients treated in the Coronary Care Unit at Arnaldo Milián Castro University Hospital from November 2018 to March 2019. They presented diagnosis of acute myocardial infarction with ST segment elevation ( N = 73); a sample of 62 patients was selected. Cluster analysis of K-means was performed and the area under ROC curve of glycated hemoglobin was assessed to predict mortality and major complications. Results: There were statistically significant differences between the clusters in the variables such as state at discharge (p = 0.001; V = 0.489) and occurrence of major cardiac complications (p = 0.050; V = 0.307). The analysis of C statistic of glycated hemoglobin established the predictive capacity for mortality in both diabetics (C = 0.810; p = 0.014) and non-diabetics (C = 0.817; p = 0.006), as well as for major cardiac complications in diabetics ( C = 0.799; p = 0.015) and non-diabetics (C = 0.683; p = 0.052). The cut-off point was established at 7.8 percent, above which glycated hemoglobin was a prognostic factor for mortality and major c. Conclusions: Glycosylated hemoglobin was stablished to have the ability to predict mortality and major cardiac complications in the in-hospital period. Its value above the cut-off point was an independent predictor(AU)

Response of the Biocontrol Agent Pseudomonas pseudoalcaligenes AVO110 to Rosellinia necatrix Exudate.

The rhizobacterium Pseudomonas pseudoalcaligenes AVO110, isolated by the enrichment of competitive avocado root tip colonizers, controls avocado white root rot disease caused by Rosellinia necatrix Here, we applied signature-tagged mutagenesis (STM) during the growth and survival of AVO110 in fungal exudate-containing medium with the goal of identifying the molecular mechanisms linked to the interaction of this bacterium with R. necatrix A total of 26 STM mutants outcompeted by the parental strain in fungal exudate, but not in rich medium, were selected and named growth-attenuated mutants (GAMs). Twenty-one genes were identified as being required for this bacterial-fungal interaction, including membrane transporters, transcriptional regulators, and genes related to the metabolism of hydrocarbons, amino acids, fatty acids, and aromatic compounds. The bacterial traits identified here that are involved in the colonization of fungal hyphae include proteins involved in membrane maintenance (a dynamin-like protein and ColS) or cyclic-di-GMP signaling and chemotaxis. In addition, genes encoding a DNA helicase (recB) and a regulator of alginate production (algQ) were identified as being required for efficient colonization of the avocado rhizosphere.IMPORTANCE Diseases associated with fungal root invasion cause a significant loss of fruit tree production worldwide. The bacterium Pseudomonas pseudoalcaligenes AVO110 controls avocado white root rot disease caused by Rosellinia necatrix by using mechanisms involving competition for nutrients and niches. Here, a functional genomics approach was conducted to identify the bacterial traits involved in the interaction with this fungal pathogen. Our results contribute to a better understanding of the multitrophic interactions established among bacterial biocontrol agents, the plant rhizosphere, and the mycelia of soilborne pathogens.

Trabajo nocturno y salud laboral / Night shift work and occupational health

El trabajo nocturno ha sido objeto de estudio en Salud Laboral por potencial riesgo para el trabajador y su repercusión en la accidentalidad. Aunque a priori cualquier trabajador puede desempeñarlo, existen excepciones legales y exigencias preventivas, entre las que destacan las derivadas de la vigilancia de la salud, en este caso obligatoria y, habitualmente, con periodicidad anual. Es normativa de referencia en trabajo nocturno la Directiva 2003/88/CE, el Estatuto de los Trabajadores, la Ley de Prevención de Riesgos Laborales y el Real Decreto de los Servicios de Prevención. La revisión realizada de la bibliografía científica (Pubmed) relaciona el trabajo nocturno con diversos problemas de salud, incluidos procesos neoplásicos. La revisión realizada de la jurisprudencia española (Westlaw Insignis) se centra en la conflictividad generada por trabajo nocturno en: menores, mujeres embarazadas o en período de lactancia, y trabajadores especialmente sensibles. Un mayor conocimiento de este tema facilitará la prevención y disminuirá la conflictividad médico-legal (AU)

Night work has been discussed in occupational health because of the potential risk to the worker and its impact on accident rates. While any worker can perform legal exceptions and preventive demands do exist, highlighting those derived from the health surveillance, mandatory in this case, and usually with annual periodicity. Reference in night work in Spain are Directive 2003/88/EC, the Workers’ Statute, the Act on Prevention of Occupational Risks and the Royal Decree for Prevention Services. In the scientific literature (Pubmed), studies relating night work to various health problems, including neoplasia, are found but without sufficient scientific evidence. The legal debate (Westlaw Insignis) is focused on exceptional situations: minors, pregnant or breastfeeding women and particularly sensitive workers. A greater understanding of this issue will facilitate the prevention of damages and prevent medicolegal problems (AU)

Tres nuevas estrategias para mejorar la precisión de la estimulación vestibular calórica monotérmica / Three new strategies to improve the accuracy of monothermal caloric screening testing

Objetivo: Encontrar una forma de estimar el valor de paresia canalicular (PC) a través de la estimulación vestibular calórica monotérmica (EVCM) que pueda utilizarse en cualquier laboratorio, controlando el error que se produce al utilizarla. Método: Se incluyó en este estudio a 2.304 pacientes de nuestro servicio a los cuales se les realizó una videonistagmografía con pruebas calóricas entre 2003 y 2011. El cálculo de la PC se realizó de 3 formas diferentes: utilizando los valores de las 4 estimulaciones calóricas (forma bitérmica) o exclusivamente con los 2 valores de una misma temperatura (formas monotérmica caliente y fría respectivamente). Se estudiaron 3 estrategias para mejorar la precisión de la EVCM: análisis de variables que empeoran la predicción, delimitación de un área gris de predicción deficiente y localización de un punto de separación entre sanos y enfermos de máxima utilidad. Resultados: 1) Corregir la fórmula de Jongkees con el valor del nistagmo espontáneo permite incluir como candidatos a la EVCM a sujetos con nistagmo espontáneo o inversión nistágmica. 2) Establecer una zona gris de predicción deficiente evita aproximadamente el 38% de las estimulaciones bitérmicas realizadas, con una sensibilidad y especificidad del 95%. 3) La máxima utilidad de la EVCM se obtiene al considerar como función vestibular normal la de sujetos con valores de EVCM caliente menores o iguales al 16%, suponiendo patológica una asimetría mayor del 20%. Conclusión: Las nuevas herramientas estadísticas permiten a los clínicos tomar decisiones que afecten al manejo de sus pacientes basados en los resultados de la EVCM (AU)

Objective: The objective was to find a way to estimate the value of inter-ear difference (IED) through monothermal caloric screening testing (MCST) that can be used at any laboratory, controlling and minimising the resulting error. Methods: We retrospectively included in this study 2304 patients from our department to whom a videonystagmography with caloric testing was performed between 2003 and 2011. The IED was calculated in 3 different ways: Using the values of the 4 caloric stimulations (bithermal form) and using only the 2 same-temperature values (warm monothermal and cool monothermal forms). We studied 3 strategies to improve the accuracy of MCST: Analysis of variables that could impair the prediction, delimitation of a grey area of insufficient prediction and location of a maximum utility cut-off point. Results: Correcting Jongkees’ formula with the value for spontaneous nystagmus makes it possible to include subjects with spontaneous nystagmus or nystagmus inversion. Establishing 2 cut-off points to classify the subjects avoids approximately 38% of bithermal stimulations performed with a sensitivity and specificity of 95%. Maximum utility was obtained diagnosing as healthy those subjects with IED values lesser than or equal to 16% in warm MCST when the pathological IED was set as greater than 20%. Conclusion: New statistical tools help clinicians to make decisions that affect their patients based on the results of MCST (AU)

Three new strategies to improve the accuracy of monothermal caloric screening testing.

OBJECTIVE: The objective was to find a way to estimate the value of inter-ear difference (IED) through monothermal caloric screening testing (MCST) that can be used at any laboratory, controlling and minimising the resulting error. METHODS: We retrospectively included in this study 2304 patients from our department to whom a videonystagmography with caloric testing was performed between 2003 and 2011. The IED was calculated in 3 different ways: Using the values of the 4 caloric stimulations (bithermal form) and using only the 2 same-temperature values (warm monothermal and cool monothermal forms). We studied 3 strategies to improve the accuracy of MCST: Analysis of variables that could impair the prediction, delimitation of a grey area of insufficient prediction and location of a maximum utility cut-off point. RESULTS: Correcting Jongkees' formula with the value for spontaneous nystagmus makes it possible to include subjects with spontaneous nystagmus or nystagmus inversion. Establishing 2 cut-off points to classify the subjects avoids approximately 38% of bithermal stimulations performed with a sensitivity and specificity of 95%. Maximum utility was obtained diagnosing as healthy those subjects with IED values lesser than or equal to 16% in warm MCST when the pathological IED was set as greater than 20%. CONCLUSION: New statistical tools help clinicians to make decisions that affect their patients based on the results of MCST.

[Validation of the eHealth Literacy Scale (eHEALS) in Spanish University Students]. / Validación de la escala eHealth Literacy (eHEALS) en población universitaria española.

BACKGROUND: One of the scales most used to measure quickly and easily eHealth Literacy is the eHealth Literacy Scale (eHEALS); however, there was no validation of this scale in Spanish. Therefore, the aim of this study was to adapt and validate the eHealth Literacy Scale (eHEALS) to the Spanish context. METHODS: Spanish translation of the scale eHEALS was administered along with other scales to measure some indicators of psychological well-being (self-esteem, subjective vitality and life satisfaction). A sample of 447 university students aged between 18 and 45 years was selected. An exploratory factor analysis, confirmatory factor analysis, analysis of invariance, reliability, temporal stability and bivariate correlations were performed. RESULTS: Exploratory factor analysis revealed a monofactorial structure that explained 52.55% of variance, with high factor loadings of the items. Reliability of 0.87 and test-retest correlation of 0.78 was obtained. The confirmatory factor analysis showed appropriate adjustments indices: χ2=66.60; p=0.00; χ2/ df=4.44; comparative fit index=0.97; incremental fit index=0.97; tucker lewis index=0.94; root mean square of approximattion =0.08; standardized root mean square residual=0.05. The questionnaire was invariant by gender. Regarding the criterion validity, a statistically significant and positive correlations between 0.12 and 0.16 with three indicators of psychological wellbeing was obtained (self-esteem, subjective vitality and life satisfaction). CONCLUSIONS: The spanish version of the eHEALS tested in this work has shown to be a valid and reliable scale to measure eHealth competence in university students.

Validación de la Escala Ehealth Literacy (Eheals) en población universitaria española / Validation of the eHealth Literacy Scale (eHEALS) in Spanish University Students

Fundamento: Una de las escalas más empleadas para medir de forma rápida y sencilla la competencia en eSalud es la eHealth Literacy Scale (eHEALS), sin embargo, no existe su validación en castellano. Por ello, el objetivo de este estudio fue adaptar y validar al contexto español la escala eHEALS. Métodos: Se administró la traducción al español de la escala eHEALS, junto a otras escalas para medir algunos indicadores del bienestar psicológico (autoestima, vitalidad subjetiva y satisfacción con la vida). Se utilizó una muestra de 447 estudiantes universitarios de edades entre los 18 y los 45 años. Se realizó un análisis factorial exploratorio, un análisis factorial confirmatorio, análisis de invarianza, de fiabilidad, de estabilidad temporal y de correlaciones bivariadas. Resultados: El análisis factorial exploratorio mostró una estructura monofactorial que explicó el 52,55% de la varianza, con elevados pesos factoriales de sus ítems. Se obtuvo una fiabilidad de 0,87 y una correlación test-retest de 0,78. El análisis factorial confirmatorio mostró unos índices de ajustes adecuados: χ2 = 66,60; p=0,00; χ2/gl=4,44; índice de ajuste comparativo =0,97); índice de ajuste incremental =0,97; índice tucker-lewis =0,94; error de aproximación cuadrático medio=0,08; residuo cuadrático medio estandarizado=0,05. No hubo diferencias por sexo. En cuanto a la validez de criterio, se obtuvieron correlaciones estadísticamente significativas y positivas e entre 0,12 y 0,16 con tres indicadores del bienestar psicológico (autoestima, vitalidad subjetiva y satisfacción con la vida). Conclusiones: La versión española de la eHEALS testada ha mostrado ser una escala válida y fiable para medir la competencia en eSalud en el alumnado universitario (AU)

Background: One of the scales most used to measure quickly and easily eHealth Literacy is the eHealth Literacy Scale (eHEALS); however, there was no validation of this scale in Spanish. Therefore, the aim of this study was to adapt and validate the eHealth Literacy Scale (eHEALS) to the Spanish context. Methods: Spanish translation of the scale eHEALS was administered along with other scales to measure some indicators of psychological well-being (self-esteem, subjective vitality and life satisfaction). A sample of 447 university students aged between 18 and 45 years was selected. An exploratory factor analysis, confirmatory factor analysis, analysis of invariance, reliability, temporal stability and bivariate correlations were performed. Results: Exploratory factor analysis revealed a monofactorial structure that explained 52.55% of variance, with high factor loadings of the items. Reliability of 0.87 and test-retest correlation of 0.78 was obtained. The confirmatory factor analysis showed appropriate adjustments indices: χ2=66.60; p=0.00; χ2/ df=4.44; comparative fit index=0.97; incremental fit index=0.97; tucker lewis index=0.94; root mean square of approximattion =0.08; standardized root mean square residual=0.05. The questionnaire was invariant by gender. Regarding the criterion validity, a statistically significant and positive correlations between 0.12 and 0.16 with three indicators of psychological wellbeing was obtained (self-esteem, subjective vitality and life satisfaction). Conclusions: The spanish version of the eHEALS tested in this work has shown to be a valid and reliable scale to measure eHealth competence in university students (AU)

Enfoque actual sobre la fisiopatología del síndrome coronario agudo / Current approach on acute coronary syndrome pathophysiology

El síndrome coronario agudo es un conjunto de entidades nosológicas que representan distintos estadios de un proceso fisiopatológico único: la isquemia miocárdica aguda, secundaria en general (pero no exclusivamente) a aterosclerosis coronaria complicada con fenómenos trombóticos que provocará distintos grados de obstrucción al flujo coronario y que en dependencia del grado de obstrucción y del estado previo del miocardio se presentará clínicamente como una angina inestable, infarto agudo del miocardio sin elevación del ST, infarto agudo del miocardio con elevación del ST o muerte súbita de causa isquémica. La presente revisión pretende abordar los principales aspectos fisiopatológicos de dicho proceso: desde la aterogénesis hasta el daño por reperfusión(AU)

Acute coronary syndrome is a number of disease entities representing different stages of a unique pathophysiologic process: acute myocardial ischemia generally secondary (but no exclusively) to coronary atherosclerosis complicated with thrombotic phenomena provoking different degrees of coronary flow obstruction and that depending of the obstruction degree and the previous status of myocardium clinically will see as a unstable angina, myocardium acute infarction with rise of ST or sudden death of a ischemic cause. Present review tries to approach the main pathophysiologic features of such process: from the atherogenesis to reperfusion damage(AU)

Clasificación actual de las miocardiopatías: un nuevo conflicto... una vieja contradicción / Present classification of Myocardiopathies: a new conflict an old contradiction

Con la publicación este año de la clasificación de las miocardiopatías según la perspectiva de la Sociedad Europea de Cardiología, se rompió un consenso de más de 13 años acerca del tema, y se ha iniciado un debate acerca de cuál de las clasificaciones vigentes es la más apropiada. Por su parte, la Sociedad Americana del Corazón defiende su propuesta, basada en un enfoque genético-molecular, con ampliación del concepto de miocardiopatía al ámbito eléctrico y manteniendo la división en primarias y secundarias, mientras la perspectiva europea expresa un claro desacuerdo en estos puntos, planteando además que su clasificación tiene más utilidad en la práctica médica diaria. En el presente artículo se describen las principales similitudes y puntos de controversia entre ambos documentos, y se emiten criterios desde el punto de vista de la cardiología clínica, el grupo principal de personales de la salud para quienes fueron realizados.

With the present classification of Myocardiopathies according the perspective of European Society of Cardiology, a consensus of more than 13 years on this matter, was broken, starting a debate on which of in use classification is the more appropriate. Heart American society defends its proposal, based on a genetic-molecular approach, with a more broad meaning of myocardiopathy to electric scope and maintaining the division of primaries and secondaries, whereas European perspective express a clear disagreement on these points, proposing also that its classification is more usefulness in daily medical practice. In present paper are described the main similarities and points of controversy between both documents with criteria from the clinical cardiology point of view, the main group of health staff for whom they were made.

Clasificación actual de las miocardiopatías: un nuevo conflicto... una vieja contradicción / Present classification of Myocardiopathies: a new conflict an old contradiction

Con la publicación este año de la clasificación de las miocardiopatías según la perspectiva de la Sociedad Europea de Cardiología, se rompió un consenso de más de 13 años acerca del tema, y se ha iniciado un debate acerca de cuál de las clasificaciones vigentes es la más apropiada. Por su parte, la Sociedad Americana del Corazón defiende su propuesta, basada en un enfoque genético-molecular, con ampliación del concepto de miocardiopatía al ámbito eléctrico y manteniendo la división en primarias y secundarias, mientras la perspectiva europea expresa un claro desacuerdo en estos puntos, planteando además que su clasificación tiene más utilidad en la práctica médica diaria. En el presente artículo se describen las principales similitudes y puntos de controversia entre ambos documentos, y se emiten criterios desde el punto de vista de la cardiología clínica, el grupo principal de personales de la salud para quienes fueron realizados(AU)

With the present classification of Myocardiopathies according the perspective of European Society of Cardiology, a consensus of more than 13 years on this matter, was broken, starting a debate on which of in use classification is the more appropriate. Heart American society defends its proposal, based on a genetic-molecular approach, with a more broad meaning of myocardiopathy to electric scope and maintaining the division of primaries and secondaries, whereas European perspective express a clear disagreement on these points, proposing also that its classification is more usefulness in daily medical practice. In present paper are described the main similarities and points of controversy between both documents with criteria from the clinical cardiology point of view, the main group of health staff for whom they were made(AU)

Externally readjustable sling for treatment of male stress urinary incontinence: points of technique and preliminary results.

BACKGROUND AND PURPOSE: Slings have been successful in the treatment of male stress urinary incontinence (SUI). However, in many situations, the sling may have either an excess of or inadequate tension, producing voiding difficulties or urinary leakage, respectively. The effectiveness of a readjustable sling for the treatment of male SUI has been evaluated. PATIENTS AND METHODS: Between October 2001 and November 2002, six consecutive male patients with SUI, aged 69 to 81 years, received a readjustable sling (Remeex) at the Monforte Comarcal Hospital. RESULTS: Five patients (83%) achieved continence, while the remaining patient showed important improvement. All patients were satisfied or very satisfied with the results. The average follow-up time was 18 months (range 12-50 months). There were no postoperative complications. CONCLUSIONS: This original treatment allows readjustment of the sling tension in the immediate or mid-term postoperative period. Initial clinical results are encouraging.

Externally readjustable device to regulate sling tension in stress urinary incontinence: preliminary results.

BACKGROUND AND PURPOSE: Slings, especially those called "tension free," have low complication rates and good long-term success rates. However, they still have problems with either an excess or a lack of tension, which produces voiding difficulties or urinary leakage persistence, respectively. The effectiveness of a new adjustable sling for the treatment of stress urinary incontinence (SUI) has been evaluated. PATIENTS AND METHODS: Between November 1999 and May 2002, 113 consecutive patients were operated for SUI by means of a new adjustable sling. The results were analyzed retrospectively. The average follow-up time was 22 months (range 6-36 months). RESULTS: Objective success was achieved in 108 of 113 patients (95.5%), but subjectively, only 90.3% of the patients were completely satisfied with the procedure because of persistent urge incontinence in 6 cases (5.3%). Morbidity was minimal. CONCLUSIONS: This new minimally invasive treatment allows readjustment of sling tension at the immediate or mid-term postoperative period. It is applicable to primary and recurrent SUI and has shown encouraging results.

Lesiones osteolíticas en la sífilis secundaria / Osteolytic lesions in secondary syphilis

Se presenta un caso de sífilis secundaria asociada a una manifestación poco frecuente, como es la osteolisis; hacemos su demostración histopatológica y revisamos brevemente la bibliografía

FTA-ABS y VDRL en suero y líquido cefalorraquideo de pacientes con carate / FTA-ABS and VDRL in serum and spinal fluid of patients with late pinta

En 41 pacientes con carate tardío se hace un estudio comparativo entre el FTA-ABS y el VDRL en suero y LCR. En suero el VDRL fue reactivo en 48% de los casos y el FTA-ABS en 68%. Ambas pruebas fueron siempre negativas en LCR. Se hace una corta discusión sobre los resultados y revisión de la literatura