SER recommendations on treatment of refractory Behçet's syndrome.

OBJECTIVE: To develop multidisciplinary recommendations based on available evidence and expert consensus for the therapeutic management of patients with refractory Behçet's syndrome (BS) (difficult to treat, severe resistant, severe relapse) to conventional treatment. METHODS: A group of experts identified clinical research questions relevant to the objective of the document. These questions were reformulated in PICO format (patient, intervention, comparison and outcome). Systematic reviews of the evidence were conducted, the quality of the evidence was evaluated following the methodology of the international working group Grading of Recommendations Assessment, Development, and Evaluation (GRADE). After that, the multidisciplinary panel formulated the specific recommendations. RESULTS: 4 PICO questions were selected regarding the efficacy and safety of systemic pharmacological treatments in patients with BS with clinical manifestations refractory to conventional therapy related to mucocutaneous and/or articular, vascular, neurological parenchymal and gastrointestinal phenotypes. A total of 7 recommendations were made, structured by question, based on the identified evidence and expert consensus. CONCLUSIONS: The treatment of most severe clinical manifestations of BS lacks solid scientific evidence and, besides, there are no specific recommendation documents for patients with refractory disease. With the aim of providing a response to this need, here we present the first official Recommendations of the Spanish Society of Rheumatology for the management of these patients. They are devised as a tool for assistance in clinical decision making, therapeutic homogenisation and to reduce variability in the care of these patients.

Estado de salud de pacientes con trasplante hepático por enfermedad relacionada con el consumo de alcohol vs. otras etiologías: estudio de cohortes / Health status of patients with liver transplantation by alcohol-related disease vs another etiology: a cohort study

Objetivo: Estudiar el estado de salud de un grupo de pacientes con trasplante hepático (TH) por enfermedad relacionada con el consumo de alcohol vs. otras etiologías, antes y después del trasplante. Método: Estudio longitudinal de cohortes en pacientes trasplantados hepáticos desde noviembre de 2019 hasta julio de 2022. Se incluyeron pacientes atendidos para un primer TH tanto electivo como urgente en la Unidad de Trasplantes de un hospital. Se excluyeron aquellos pacientes que ya portaban un órgano trasplantado y aquellos que necesitaron un re-TH en el primer mes tras el primer trasplante. Se recogieron variables sociodemográficas y clínicas, Model for End-Stage Liver Disease (MELDNa), índice de fragilidad hepática (LFI), efectos emocionales-conductuales del trasplante, nivel de ansiedad y depresión. En el análisis estadístico se utilizaron las pruebas de X2 de Pearson, t de Student, U de Mann-Whitney y el signo de Wilcoxon. Resultados: La muestra fue n = 67 pacientes trasplantados hepáticos, con una edad promedio de 56,37 años, siendo 67,2% hombres y 39% por enfermedad hepática relacionada con el alcohol (EHRA). De todos los pacientes incluidos, 9% fueron trasplantes urgentes. El consumo de alcohol se asoció con una mayor edad, una alta tasa de fragilidad hepática y una situación laboral no activa. La etiología alcohólica se correlacionó con una mayor preocupación durante los primeros seis meses después del trasplante de hígado. Conclusión: Existen diferencias en el estado de salud de los pacientes trasplantados hepáticos por EHRA vs. otra etiología. Las enfermeras deben considerar la etiología de la enfermedad hepática para orientar los cuidados y las intervenciones durante todo el proceso de trasplante.(AU)

Aim: To study the health status of a group of patients with liver transplantation by alcohol-related disease vs another etiology before and after the transplantation. Method: Longitudinal cohort study of liver transplant patients from November 2019 to July 2022. Adult patients attended in the unit of transplantation of a hospital for a first liver transplant, both elective and urgent, were included. Patients who already had a transplanted organ and those who required liver re-transplantation in the first month after the first transplant were excluded. Sociodemographic and clinical variables, MELDNa, liver frailty index, emotional-behavioral effects of transplantation, level of anxiety and depression were collected. Pearson's chi-square, Student's t, Mann-Whitney U, and Wilcoxon sign tests were used for statistical analysis. Results: The sample was n = 67 liver transplant patients with a mean age of 56.37 years, 67.2% being men and 39% due to alcohol-related liver disease. 9% of all included patients were urgent transplants. Alcohol consumption was associated with older age, a high rate of liver frailty, and a non-active work situation. Alcoholic etiology correlated with increased concern during the first six months after liver transplantation. Conclusion: There are differences in the health status between liver transplant patients for alcohol-related liver disease vs other etiology. Nurses must consider the etiology of liver disease to guide care and interventions throughout the transplant process.(AU)

Health status of patients with liver transplantation by alcohol-related disease vs another etiology: A cohort study.

AIM: To study the health status of a group of patients with liver transplantation by alcohol-related disease vs another etiology before and after the transplantation. METHOD: Longitudinal cohort study of liver transplant patients from November 2019 to July 2022. Adult patients attended in the unit of transplantation of a hospital for a first liver transplant, both elective and urgent, were included. Patients who already had a transplanted organ and those who required liver re-transplantation in the first month after the first transplant were excluded. Sociodemographic and clinical variables, MELDNa, liver frailty index, emotional-behavioral effects of transplantation, level of anxiety and depression were collected. Pearson's chi-square, Student's t, Mann-Whitney U, and Wilcoxon sign tests were used for statistical analysis. RESULTS: The sample was n = 67 liver transplant patients with a mean age of 56.37 years, 67.2% being men and 39% due to alcohol-related liver disease. 9% of all included patients were urgent transplants. Alcohol consumption was associated with older age, a high rate of liver frailty, and a non-active work situation. Alcoholic etiology correlated with increased concern during the first six months after liver transplantation. CONCLUSION: There are differences in the health status between liver transplant patients for alcohol-related liver disease vs other etiology. Nurses must consider the etiology of liver disease to guide care and interventions throughout the transplant process.

Psychological Status of the Participants in Alzheimer's Prevention Initiative Autosomal Dominant Alzheimer's Disease Colombia.

BACKGROUND: The SARS-CoV2 global pandemic impacted participants in the Alzheimer's Prevention Initiative (API) Autosomal Dominant Alzheimer's Disease (ADAD) clinical trial, who faced three stressors: 1) fear of developing dementia; 2) concerns about missing treatment; and 3) risk of SARS-CoV2 infection. OBJECTIVE: To describe the frequency of psychological disorders among the participants of the API ADAD Colombia clinical study, treated by a holistic mental health team during the COVID-19 pandemic. The extent of use of mental health team services was explored considering different risk factors, and users and non-users of these services were compared. METHODS: Participants had free and optional access to psychology and psychiatry services, outside of the study protocol. Descriptive statistics was used to analyze the frequency of the mental health difficulties. A multivariable logistic regression model has been used to assess associations with using this program. RESULTS: 66 participants were treated by the Mental Health Team from March 1, 2020, to December 31, 2020. Before and after the start of the pandemic, the most common psychological problems were anxiety (36.4% before, 63.6% after) and depression (34.8% before, 37.9% after). 70% of users assisted by psychology and 81.6% of those assisted by psychiatry felt that the services were useful for them. Female sex, depression, and anxiety before the pandemic were positively associated with being assisted by either psychology or psychiatry, while the association with hyperlipidemia was negative. CONCLUSIONS: A holistic mental health program, carried out in the context of a study, could mitigate psychopathology during pandemics such as COVID-19.

Resilience After COVID-19: A Descriptive, Cross-Sectional Study.

The main purpose of this study was to examine the relationship between resilience and health-related quality of life in patients following COVID-19 disease among those with and without lingering symptoms. The study design is descriptive and cross-sectional. Participants (n = 97) were adults who had earlier contracted COVID-19 disease and were in post-infection status between July and October 2020. Participants completed the following instruments: Connor-Davidson Resilience Scale, Short-Form 12-item Health Survey, and Hospital Anxiety and Depression Scale. Approximately 35% post-COVID-19 patients had a low level of resilience. The impact on the health status and resilience of those who had reported symptoms after 6 months was also significant. Age and depression had a significant impact on level of resilience. This relationship can affect patient recovery and negatively impact the ability to cope with COVID-19 disease. It is necessary to implement specialized training for clinicians on the effects of long-term COVID-19 to improve patient care. Long COVID symptoms might manifest months after an acute COVID-19 illness; clinicians who can confirm patient reports of these symptoms may help patients recover and become more resilient.

Alteraciones neuropsiquiátricas en menores de 18 años expuestos a opioides en el periodo prenatal: Revisión Narrativa

El consumo de opioides ha venido incrementando en los últimos años, generando una crisis de salud pública que afecta a todo tipo de población. El uso de sustancias opiáceas ilegales en embarazadas también está en incremento, por lo que, en la práctica clínica se evidencian con mayor frecuencia resultados neonatales adversos como el síndrome de abstinencia neonatal (NAS). Adicionalmente, los niños expuestos prenatalmente a estas sustancias pueden sufrir alteraciones cognitivas, motoras o psiquiátricas durante el transcurso de su vida. Este artículo tiene como objetivo proporcionar una revisión de la literatura actualizada acerca del uso de opioides durante el embarazo y las consecuencias para los niños expuestos a estas sustancias.

Opioid consumption has increased greatly in recent years, creating a public health crisis that affects all types of population. The use of illegal opiates amongst pregnant women has also risen, causing a surge in the frequency in which adverse neonatal outcomes, such as Neonatal Abstinence Syndrome (NAS), are seen in clinical practice. Furthermore, children exposed prenatally to these substances have cognitive, motor and psychiatric adverse outcomes throughout their lifetime. This article's objective is to provide an updated literature review about opioid use during pregnancy and its consequences on children exposed in-utero.

Intraocular pressure values during the water drinking test in a Colombian population / Comportamiento de la presión intraocular durante la prueba de sobrecarga hídrica en población colombiana

Background: Intraocular pressure (IOP) peaks are key factors on the onset and progression of glaucoma. The water drinking test (WDT) detects IOP fluctuations and estimates the maximum IOP. Objective: To assess the IOP variations during the WDT in patients diagnosed or suspected of glaucoma treated at an ophthalmology clinic. Methods: This is an observational, descriptive, and retrospective study, using clinical records of patients whom underwent the WDT between January 2017 and August 2019. Results: The study included 300 eyes. The WDT was positive in 23.3% of the eyes. Basal IOP at 15, 30, and 45 min, as well as the maximum pressure, presented a similar mean, median, and mode, as well as a varying coefficient without much variability. The negative test group had a maximum IOP of 18.9 mmHg, compared with 20.3 mmHg in the positive test group. Conclusion: In a Colombian cohort of patients with diagnosed or suspected glaucoma whom underwent a WDT, 23.3% had positive result. 90% of the tests were positive at the 30-min interval. This test is a complementary tool in the follow-up of patients with glaucoma.

Introducción: Los picos de presión intraocular son factores importantes para la aparición y progresión del glaucoma. La prueba de sobrecarga hídrica permite detectar fluctuaciones de presión intraocular y estimar la presión máxima. Objetivo: Evaluar las variaciones en la presión intraocular durante la prueba de sobrecarga hídrica en pacientes de una clínica oftalmológica. Métodos: Estudio observacional, descriptivo, retrospectivo de revisión de historias clínicas de pacientes sometidos a la prueba de sobrecarga hídrica entre enero de 2017 y agosto de 2019. Resultados: Se incluyeron 300 ojos. La prueba de sobrecarga hídrica fue positiva en el 23,3% de los ojos. La presión intraocular basal, a los 15, 30 y 45 min, al igual que la presión máxima, tuvieron una media, mediana y moda similares, con un coeficiente de variación sin mucha variabilidad. El grupo con resultados negativos tuvo una presión intraocular máxima de 18,9 mmHg comparado con 20,3 mmHg del grupo con resultados positivos. Conclusión: En una cohorte colombiana de pacientes con diagnóstico o sospecha de glaucoma quienes se les realizó la prueba de sobrecarga hídrica, el 23,3% tuvo resultados positivos. El 90% de las pruebas fueron positivas en el intervalo de 30 min. Esta prueba es una herramienta complementaria en el seguimiento de pacientes con glaucoma.

Análisis del impacto del trasplante hepático como condicionante de salud / Analysis of the impact of liver transplantation as a condition of health

Objetivo: Analizar el impacto que el trasplante hepático ha tenido en el paciente como condicionante de su estado de salud. Método: Se realizó un estudio prospectivo, cuya muestra la formaron aquellos pacientes trasplantados hepáticos en el Hospital General Universitario Gregorio Marañón desde noviembre 2019 hasta agosto 2021. Se utilizaron la escala hospitalaria de ansiedad y depresión, el Modelo para enfermedad hepática en estadio terminal sodio, el índice de fragilidad hepática y el cuestionario efectos del trasplante. Se utilizaron la prueba t de Student para las variables continuas y la prueba de chi-cuadrado para las categóricas. Para aquellas muestras no paramétricas se utilizaron el signo de Wilcoxon, U de Mann-Whitney y Kruskal-Wallis. Resultados: La muestra la conformaron 60 pacientes con una media de edad de 55,68 años, siendo el 70% hombres. La puntuación media de ansiedad y depresión de los pacientes mejoró significativamente tras el trasplante hepático. El impacto de la salud física resultó en que aquellos pacientes con un mayor índice del Modelo para enfermedad hepática en estadio terminal sodio se correlacionaron con un mayor sentimiento de culpa tras el trasplante. Además, una mayor adherencia al tratamiento inmunosupresor se correlacionó directamente con una mayor revelación e inversamente con la culpa, tras el trasplante. Conclusión: El trasplante hepático es un proceso que impacta en la salud de los pacientes. Aquellos pacientes que llegan al trasplante con una situación física más deteriorada presentan una mayor culpa tras el trasplante. Dicho impacto se correlaciona inversamente con la adherencia al tratamiento inmunosupresor. Las enfermeras deben intervenir en dichos pacientes para reducir el impacto en la adherencia al tratamiento.(AU)

Aim: To analyse the impact that liver transplantation has had on the patient as a condition of their health. Method: A prospective study was carried out, the sample of which was made up of liver transplant patients at the Gregorio Marañón General University Hospital from November 2019 to August 2021. The hospital anxiety and depression scale, the Model for End-stage liver disease sodium and liver fragility index and the Transplant Effects Questionnaire Spanish were used. The data were analysed using descriptive statistics. The Student's t test was used for continuous variables and the chi-square test for categorical variables. For non-parametric samples, the Wilcoxon, Mann-Whitney U test and Kruskal-Wallis's sign were used. Results: The sample was made up of 60 patients with a mean age of 55.68 years, 70% being men. The mean anxiety and depression scores of the patients improved significantly after liver transplantation. The impact of physical health resulted that those patients with a higher Model for End-stage liver disease sodium were correlated with a greater feeling of guilt after transplantation. Furthermore, greater adherence to immunosuppressive treatment was directly correlated with greater disclosure and inversely with guilt, after transplantation. Conclusion: Liver transplantation is a process that impacts the health of patients. Those patients who arrive at the transplant with a more deteriorated physical situation present a greater guilt after the transplant. This impact is inversely correlated with adherence to immunosuppressive treatment. Nurses should intervene in such patients to reduce the impact on adherence to treatment.(AU)

Analysis of the impact of liver transplantation as a condition of health.

AIM: To analyse the impact that liver transplantation has had on the patient as a condition of their health. METHOD: A prospective study was carried out, the sample of which was made up of liver transplant patients at the Gregorio Marañón General University Hospital from November 2019 to August 2021. The hospital anxiety and depression scale, the Model for End-stage liver disease sodium and liver fragility index and the Transplant Effects Questionnaire Spanish were used. The data were analysed using descriptive statistics. The student's t-test was used for continuous variables and the chi-square test for categorical variables. For non-parametric samples, the Wilcoxon, Mann-Whitney U test and Kruskal-Wallis's sign were used. RESULTS: The sample was made up of 60 patients with a mean age of 55.68 years, 70% being men. The mean anxiety and depression scores of the patients improved significantly after liver transplantation. The impact of physical health resulted that those patients with a higher Model for End-stage liver disease sodium were correlated with a greater feeling of guilt after transplantation. Furthermore, greater adherence to immunosuppressive treatment was directly correlated with greater disclosure and inversely with guilt, after transplantation. CONCLUSION: Liver transplantation is a process that impacts the health of patients. Those patients who arrive at the transplant with a more deteriorated physical situation present a greater guilt after the transplant. This impact is inversely correlated with adherence to immunosuppressive treatment. Nurses should intervene in such patients to reduce the impact on adherence to treatment.

Pacemaker pocket infection by Nocardia carnea. First case description and literature review.

Acid-fast gram-positive bacilli are a seldom causal agent of cardiac implantable electronic devices (CIED) infections. A pacemaker pocket infection by Nocardia carnea is presented. The objective of this review is to know the incidence of pacemaker pocket infection by Nocardia and to collect information to contribute to the management of this infection. We describe both our case and those found in the literature. Only three cases were found. Two of the patients were older than 70 years without immunosuppression, presenting erythema at the pacemaker implantation site as main symptom. Bloodstream infection was registered in one of them. Three microorganisms were sensitive to cotrimoxazole. The minimum time of antibiotic therapy was 6 weeks. An incomplete device removal was done in one case, resulting in an unfavorable clinical course. The incidence of pacemaker pocket infection by these microorganisms is low, resolved in most cases with antibiotic treatment and device removal.

Infección urinaria comunitaria: etiología, resistencias y perfil del paciente en un hospital de referencia / Community-acquired urinary tract infections: Etiological, resistance and patient's profile at a tertiary hospital

No disponible

Tuberculosis in indigenous communities of Antioquia, Colombia: epidemiology and beliefs.

Morbidity and mortality caused by tuberculosis are increased in most of the Latin-American indigenous communities. Factors that could explain this situation are poverty and limited health services access due to social conflicts and geographical isolation. We determined the frequency of tuberculosis in Colombian indigenous communities and described their knowledge related to transmission and control. We developed a descriptive study and health survey. Interviews were performed to find ancestral knowledge about tuberculosis. Sputum samples from patients with respiratory symptoms were analyzed. 10 indigenous communities were studied, which tuberculosis incidence was 291/100,000. Communities believe that tuberculosis is a body and spirit disease, which transmission is by direct contact or by witchcraft. Tuberculosis incidence in the studied communities was ninefold higher than that of the general population from Antioquia Department. Knowledge exchange could facilitate the community empowerment and implementation of educational activities which might improve the control of the disease.

Eficacia del bloqueo facetario en pacientes con síndrome facetario lumbar / Efficacy of facet block in patients with lumbar facet joint syndrome

El bloqueo facetario es un procedimiento usado en aquellos pacientes con artrosis facetaria en los cuales han fallado los múltiples tratamientos médicos. En nuestro país se desconocen estudios o estadísticas que demuestren su efectividad, por lo que se consideró pertinente demostrarlo. Se realizó un estudio observacional retrospectivo de una cohorte de pacientes intervenidos en el período comprendido entre enero de 2005 y diciembre de 2009 en la Clínica CES. Se recolectó información de las historias clínicas mediante un formulario diseñado para tal fin; además se relacionó la existencia de mejoría del paciente posterior a la intervención con edad, sexo, ocupación, tiempo de evolución, síntomas motores y sensitivos previos y enfermedades asociadas. La población fue de 232 pacientes entre 21 y 92 años, con una edad promedio de 56,9 (± 14,6) años, con un tiempo de evolución del dolor lumbar de 2 años en el 40% de la población estudiada. La resonancia magnética fue el estudio más utilizado previo al procedimiento en 42,2% de los pacientes, la tomografía en 38,31% y los rayos X en 7,46%. El procedimiento fue eficaz en el 78% de los pacientes. En conclusión, el bloqueo facetario es un método terapéutico, ya que se vio mejoría de la sintomatología en la mayoría de los pacientes estudiados. Esto es coherente con otros estudios realizados, donde también se ha evidenciado disminución de las limitaciones físicas y funcionales de los pacientes. Además, es un procedimiento diagnóstico ya que la mejoría con esta técnica indica que la patología sí era facetaria.

Facet block is a procedure used in patients with facet arthrosis in which several other medical techniques have failed. In our country, there is no evidence or studies regarding its efficacy, thus the interest in its demonstration. A retrospective observational cohort study was carried out on patients intervened between January 2005 and December 2009 at Clínica CES. Data was collected from the patient's clinical records by means of a survey designed for that purpose. Also, positive clinical outcomes were correlated to age, gender, occupation, evolution time, motor and sensitive symptoms as well as comorbidities. The sample included 232 patients between the ages of 21 and 92, with an average age of 56.9 (± 14.6) years, and a lumbar pain evolution time of 2 years in 40% of the individuals in the sample. The most commonly used imaging test before the procedure was magnetic resonance imaging in 42.2% of patients, computed tomography scan was used in 38.31% and X-rays in 7.46%. The procedure was effective in 78% of patients. In sum, facet block is a therapeutic method, given that most patients improved after its completion. These findings are consistent with other studies that have showed a decrease in physical and functional limitations of the patients. Besides, improvement of the patient's state confirms a lumbar facet syndrome, so it is a diagnostic procedure as well.

Promoción farmacéutica y factores tenidos en cuenta para la prescripción médica. Medellín, Colombia, 2011 / Factors taken into account for the prescription and pharmaceutical promotion. Medellín, Colombia, 2011

RESUMEN Estudio observacional descriptivo transversal realizado en 2011 en una muestra por conveniencia de 128 médicos generales y especialistas de la ciudad de Medellín (Colombia). Se utilizó para la toma de información una encuesta anónima, autodiligenciada que contenía información sociodemográfica, mejores estrategias publicitarias empleadas por la industria farmacéutica, criterios considerados para la prescripción médica y fuente de información habitualmente consultada. Los resultados mostraron que los hombres representaron el 57% de los participantes, el promedio de edad fue de 35±11 años y dos de cada cinco eran médicos generales. Los médicos consideraron como mejores estrategias de promoción farmacéutica las invitaciones a congresos (86%) y las muestras promocionales (77%). En promedio se recibía una visita mensual del visitador médico, y la asistencia a eventos patrocinados por la industria farmacéutica fue del 61% en el último año. Tan sólo el 3% de los participantes manifiesta tener en cuenta la recomendación de un visitador al momento de prescribir, prefiriendo la experiencia con el fármaco (92%), los estudios de efectividad (91%) y la inclusión en los protocolos clínicos (69%). Este estudio concluye que a pesar del uso de algunas estrategias promocionales por la industria farmacéutica, su influencia no es un factor determinante en los hábitos de prescripción médica, ya que son considerados otros criterios.

SUMMARY Cross-sectional study carried out in 2011 in a sample by convenience of 128 general practitioners and specialists from the city of Medellín (Colombia). A self-reported anonymous survey was made containing information sociodemographic, best advertising strategies employed by the pharmaceutical industry, criteria for medical prescription and usually consulted information source. The results showed that 57% of the participants were men, the median age was 35±11 years and two of every five were general practitioners. Best strategies of promotion pharmaceutical considered by practitioners were: invitations to congresses (86%) and promotion of samples (77%). On average, each practitioner received a monthly visit by visitor medical, and attendance at events sponsored by the pharmaceutical industry was 61% in the last year. Only 3% of participants take into account the recommendation of a visitor to prescribe, preferring the experience with the drug (92%), studies of effectiveness (91%) and inclusion in the clinical protocols (69%). The conclusion of this study is that despite the use of some promotional strategies for the pharmaceutical industry, its influence is not a determinant in prescription habits that are considered to be other criteria.

El microbiólogo y la infección asociada a catéter / The microbiologist and the catheter related infection

La infección relacionada con el catéter (IRC) es una patología cadavez más prevalente en el medio hospitalario como así hanpuesto de manifiesto los estudios epidemiológicos multicéntricosque se realizan anualmente como ENVIN-HELICS o EPINE. En eldiagnóstico de esta entidad el microbiólogo desempeña un papelprotagonista, ya sea recomendando qué tipo de catéteres debenestudiarse para el diagnóstico de confirmación, en qué momentodeben enviarse estas muestras, cuándo está indicado la realizaciónde estudios microbiológicos de vigilancia del catéter, qué resultadosson clínicamente significativos y como deben informarseal clínico. El objetivo de esta revisión es examinar los distintosaspectos de la IRC como son la patogenia, la etiología, la epidemiologíay realizar una puesta al día de los diferentes métodosdiagnósticos microbiológicos, tanto los conservadores como losque implican la retirada del catéter(AU)

Different multicentre epidemiological studies such asENVIN-HELICS or EPINE, have remarked that catheter relatedbloodstream infection (CRBI) is an increasingly condition inhospital environment. The microbiologist plays a major role inthe diagnosis, either by recommending what type of cathetermust be considered for confirmatory diagnosis, when thesesamples must be sent for culture, when is indicated to performsurveillance studies of the catheter and what results areclinically significant to be informed. In this paper, different aspects of the CRBI, such as the pathogenesis, etiology,epidemiology and diagnosis are reviewed. The differentmicrobiological diagnostic methods, both conservatives andthose involving the removal of the catheter are up-to-dated(AU)

[Organization of the visits in an intensive coronary care unit: opinion of all the implied people]. / Organización de las visitas en la unidad de cuidados intensivos coronarios: opinión de todas las personas implicadas.

Considering the present coexistence in our unit of different criteria that guide the rules and visits timetable of the relatives, the objective of this study is to know the opinion of all the implied people in the clinic relation (sanitary staff, patients and relatives), about the rules of the visit in our Coronary Unit to compare, discuss and bring the protocol unit up to date. This is an observational and transversal study in which 40 sanitary staff, 56 patients and 53 relatives have been surveyed. The study was developed in 2002, and a survey made by us was used to collect the next parameters: number and length of the visits, profits and troubles when the visit timetable is more flexible; opinion about the waiting room; and the convenience or not of using the mobile phone for the patient. For doing the statistical analysis it has been calculated the distribution of the frequencies of the results, and the Chi2 test. In general, the sanitary staff is who has a more positive attitude for visiting, being nurses particularly the most flexible, considering the patients'condition. Relatives and patients have the same opinion more or less but they aren't so flexible.

Asistencia hospitalaria al personal de tropa de reemplazo en la plaza de Ceuta entre 1993 y 1997 / Hospital care for personnel performing compulsory military service in the Ceuta enclave from 1993 to 1997

Se exponen y analizan en el presente trabajo los datos obtenidos sobre la asistencia que el Hospital Militar O'Donnell de Ceuta ha venido prestando al personal de tropa destinado en la plaza de Ceuta entre los años 1.993 y 1.997. Se estudiaron datos referentes al número de asistencias, ingresos, intervenciones quirúrgicas, consultas externas, evacuaciones y dictámenes de los Tribunales Médicos Militares, así como su distribución en función de las unidades (legión, regulares, agrupación logística, etc.) y las especialidades médicas. Del estudio se obtienen algunos resultados interesantes como el alto índice de asistencias e ingresos entre jóvenes sanos y la escasa diferencia que a este respecto existe entre unidades operativas y no operativas aún a pesar de existir una mayor peligrosidad entre las primeras. Asimismo, se pretende que estos datos puedan servir de referencia de cara a un futuro estudio comparativo, una vez que las Fuerzas Armadas estén integradas por soldados profesionales (AU)