A new method based on dispersive solid phase microextraction with commercial MOFs coupled to LC-MS/MS for the determination of isoflavones in soy drinks.

For the first time, a method based on dispersive solid phase microextraction (D-µSPE) using commercial metal-organic frameworks coupled to liquid chromatography-triple quadrupole tandem mass spectrometry (LC-MS/MS) has been proposed for the determination of isoflavones in soy drinks. The use of commercial sorbents simplifies the sample treatment procedure and allows their application to routine analysis. Optimization of the parameters involved in the microextraction process was carried out using a Box-Behnken experimental design. Under the optimized conditions, the limits of detection ranged between 2 and 7 µg L-1; the intra-day and inter-day precision were <10 and 20%, respectively, and the recoveries were in the range of 61-120%. No significant matrix effect was found, which allowed the use of external standard calibration method. The method was successfully applied to the determination of isoflavones in commercial soy milk samples.

Rapid identification, capsular typing and molecular characterization of Streptococcus pneumoniae by using whole genome nanopore sequencing.

BACKGROUND: Whole genome sequencing has emerged as a useful tool for identification and molecular characterization of pathogens. MinION (Oxford Nanopore) is a real-time third generation sequencer whose portability, affordability and speed in data production make of it an attractive device for whole genome sequencing. The objective of this study is to evaluate MinION sequencer for pathogen identification and molecular characterization of Streptococcus pneumoniae isolated at a children's Hospital. Whole genome sequencing of 32 Streptococcus pneumoniae invasive isolates, previously characterized by standard methods (Quellung reaction, Multiplex PCR and Sanger-MLST), were performed. DNA was extracted using ZymoBIOMICS DNA Microprep kit. Quantification and purity of DNA was assessed by Qubit and Nanodrop, respectively. Library preparation was performed using the Rapid Barcoding Kit. Real-time workflow EPI2ME platform "What's it in my pot" was used for species identification. Fast5 sequences were converted into FASTQ by Albacore software. Reads were assembled using CANU software. PathogenWatch, genomic epidemiology and pubmlst online tools were used for capsular typing and/or whole genome-MLST profile. RESULTS: Rapid identification of Streptococcus pneumoniae was achieved by "What's in my pot". Capsular typing was correctly assigned with PathogenWatch in all 32 isolates at serogroup level and 24 at serotype level. Whole genome-MLST results obtained by genomic epidemiology and pubmlst were consistent with double locus variant clonal complex obtained by Sanger-MLST in 31 isolates. CONCLUSION: MinION sequencer provides a rapid, cost-effective and promising pathway for performing WGS by a pocked-sized device for epidemiological purposes but improving its sequencing accuracy will make it more appealing to be used in clinical microbiology laboratories.

Head trauma in the haemophilic child and management in a paediatric emergency department: Descriptive study.

INTRODUCTION: Haemophilia is one of the most common inherited bleeding disorders in the Emergency Department (ED). The most dangerous site of bleeding is the central nervous system. AIMS: To describe the characteristics of haemophiliacs arrived to our ED following a head trauma and to analyse the incidence of intracranial haemorrhage (ICH). MATERIALS AND METHODS: Retrospective, analytical, observational study, conducted in a Paediatric ED. We included haemophilic patients aged from birth to 16 years who consulted after a head trauma over a 6-year period. Data collected included age, type of haemophilia and head trauma, symptoms, prophylaxis status, CT imaging, treatment and number of visits to the ED. RESULTS: About 46 males and 85 episodes were analysed. The median age was 2.38 years. Severe haemophilia A was the most frequent type of disease (50%). All head injuries were mild, and the most frequent mechanism was a collision with an object (38.8%). In 62 episodes (72.9%) the patients were asymptomatic. The rest 23 events had symptomatology, being the most common headache (26%), emesis (21.7%) and drowsiness (17.4%). Head CT was obtained in 31 episodes, founding altered results in 10 (6 of them corresponding to ICH). All the patients with ICH had symptomatology. About 37 episodes required admission. CONCLUSION: Intracranial haemorrhage is one of the most dangerous events in haemophiliacs and it may occur after a head trauma. Our study suggests that, in case of head trauma, CT must be obtained in symptomatic patients and in those with additional risk factors. Asymptomatic patients must have prolonged observation.

[Childhood ischemic cerebrovascular disease in a paediatric emergency service: a descriptive study]. / Enfermedad cerebrovascular de tipo isquemico posnatal en urgencias pediatricas: estudio descriptivo.

AIM: To describe the clinical presentation, risk factors and complementary tests in patients of our paediatric emergency service with a final diagnosis of ischemic stroke. PATIENTS AND METHODS: Retrospective, analytical and observational study, performed in a Paediatric Emergency Service of a tertiary-level hospital. We included patients aged 1 month to 14 years during a 12-years period with a final diagnosis of ischemic cerebrovascular disease (CVD). We analyzed personal history, symptomatology and initial complementary tests. RESULTS: Twelve patients were included, 66% males, with a median age of 77 months. 42% had remarkable history. The most frequent clinical manifestation was motor disorder (75%). 42% were diagnosed in the first 24 hours, noticing an earlier diagnosis after the introduction of a multidisciplinary protocol about CVD. CT was performed in all patients, except in two cases in whom MRI was performed. 50% of the CTs were initially normal. In the etiological study developed lately, only 42% of the patients had risk factors. 91% had some kind of sequel. CONCLUSIONS: CVD is uncommon in pediatrics, but with a high morbimortality, so it is important to make an early diagnosis. Clinical and personal history are fundamental, nevertheless, we mainly deal with a previously healthy child without known risk factors at the time of the first evaluation. In case of clinical suspicion of stroke, a normal initial CT does not rule out a CVD, so other additional tests, such as MRI, are necessary.

TITLE: Enfermedad cerebrovascular de tipo isquemico posnatal en urgencias pediatricas: estudio descriptivo.Objetivo. Describir la presentacion clinica, los factores de riesgo y las pruebas complementarias realizadas en pacientes atendidos en urgencias con diagnostico de ictus isquemico. Pacientes y metodos. Estudio retrospectivo, analitico observacional, realizado en urgencias pediatricas de un hospital de tercer nivel. Se incluyeron pacientes entre 1 mes y 14 años durante 12 años, con diagnostico de enfermedad cerebrovascular (ECV) de tipo isquemico. Se analizaron los antecedentes personales, la sintomatologia y las pruebas complementarias iniciales. Resultados. Se recogieron 12 pacientes (66% varones), con una mediana de edad de 77 meses. El 42% presento algun antecedente reseñable. La manifestacion clinica mas frecuente fue la alteracion motora (75%). El 42% fueron diagnosticados en las primeras 24 horas, y se objetivo un diagnostico mas temprano tras la introduccion de un programa multidisciplinar sobre manejo de la ECV. En todos se realizo inicialmente una tomografia axial computarizada (TAC) craneal, salvo en dos casos en los que se hizo una resonancia magnetica. La mitad de las TAC fueron normales al inicio. En el estudio etiologico posterior se encontraron factores de riesgo solo en cinco pacientes (42%). El 91% presento algun tipo de secuela. Conclusiones. La ECV es poco frecuente en pediatria, con elevada morbimortalidad, y es importante realizar un adecuado diagnostico precoz. Son fundamentales la historia clinica y los antecedentes personales, aunque en la valoracion inicial es frecuente encontrarse ante niños sanos sin factores de riesgo conocidos en ese momento. Ante la sospecha clinica de ictus, una TAC craneal inicial normal no descarta una ECV y son necesarias otras pruebas, como la resonancia magnetica.

Utilidad de la punción lumbar y el urocultivo en el estudio de la fiebre sin foco en niños menores de 1 mes en el servicio de urgencias pediátricas: estudio descriptivo / Utility of lumbar puncture and urine culture for the study of fever without source in neonates in pediatric emergency departments: A descriptive study

Introducción: La fiebre sin foco en el recién nacido constituye un motivo de consulta frecuente en los servicios de urgencias pediátricas. En los últimos años han surgido diferentes enfoques sobre su manejo, y se tiende a un abordaje conservador en cuanto a la realización de exploraciones complementarias. Materiales y métodos: Estudio descriptivo retrospectivo de las historias clínicas de los menores de 1 mes atendidos en nuestro servicio de urgencias pediátricas por fiebre sin foco durante los años 2011-2013. Resultados: Se analizaron 146 casos. Se realizó urocultivo en el 98,6% de los casos y un cultivo del líquido cefalorraquídeo (LCR) en el 91,1%. En el 13,6%, el urocultivo resultó positivo, y el microorganismo más frecuente fue Escherichia coli (75%). El 28,8% presentó un LCR positivo, lo que supone el 95,2% de los casos de infecciones por enterovirus, sin aislarse ningún agente bacteriano. Hemos encontrado una relación estadísticamente significativa (p < 0,002) entre los pacientes que presentaron valores más elevados de temperatura y los cultivos de LCR positivos para enterovirus, así como entre los que presentaron mayores recuentos de leucocitos en sangre con cultivo de orina y LCR patológicos (p < 0,001 y p = 0,019, respectivamente). Conclusión: Los neonatos febriles suponen un grupo de riesgo para el desarrollo de una infección bacteriana grave, por lo que es importante realizar una búsqueda etiológica exhaustiva, con estudio de sangre, orina y LCR, independientemente de su rango de edad. La indicación de las exploraciones complementarias no puede basarse exclusivamente en los hallazgos obtenidos en la anamnesis y la exploración física (AU)

Introduction: Unexplained fever in newborn infants represents a common visit to the pediatric emergency departament (ED). In the last few years different views about its management had arosen, with a tendency towards being conservative about complementary exams. Materials and methods: Descriptive, retrospective study based on clinical data of newborn infants (less than 1 month old) in our ED department with unexplained fever between 2011-2013. Results: Data for 146 patients were analyzed. Urine culture was done in 98.6% of the patients and cerebrospinal fluid culture in the 91.1%. Urine culture turned out positive in the 13.6%, being Escherichia coli the most common microorganism (75%). In the 28.8% of the cases, the sample of cerebrospinal fluid turned up positive, assuming in the 95.2% of the cases, enterovirus infections without a bacterial agent being isolated. We have found a statistical significative relation (p < 0.002) between patients with higher temperature levels and cerebrospinal fluid positive cultures for enterovirus as well as between the ones with higher white blood cell count with positive cerebrospinal fluid and urine cultures (p < 0.001 y p = 0.019, respectively). Conclusion: Febrile newborn infants are a risk group for developing serious bacterial infections, highlighting the importance of an exhaustive etiological study, with blood, urine and cerebrospinal fluid studies, regardless their age group. The indication of complementary exams must not be based only on anamnesis or physical examination (AU)

Utilidad del límite inferior de normalidad de la espirometría en pacientes diagnosticados de EPOC / Utility of normality low limit of spirometry in diagnosed COPD patients

Objetivo. Evaluar las diferencias en los pacientes de EPOC situados por debajo del límite inferior de normalidad (LIN) de la proporción fija FEV1/FVC < 0,70 y los situados por encima de dicho límite. Pacientes y métodos. Estudio transversal. Se seleccionó una muestra aleatoria de pacientes con diagnóstico de EPOC entre 40 y 85 años de la base de historias clínicas informatizada de Atención Primaria. Se les realizó espirometría basal y posbroncodilatación. Se establecieron 2 grupos de pacientes: con FEV1/FVC < 0,70 y ≤ LIN (grupo 1) y con FEV/FVC < 0,70 y > LIN (grupo 2). Se midieron variables sociodemográficas, clínicas, de obstrucción pulmonar, frecuentación a servicios sanitarios y de calidad de vida. Se compararon los resultados en ambos grupos. Resultados. El 22,3% de los sujetos tenían un diagnóstico erróneo (FEV1/FVC>0,7). Los pacientes del grupo 2 fueron diagnosticados a edades superiores, tenían menor exposición tabáquica y mejor función pulmonar (FEV1: 74,9% vs. 54,6%). El 35,5% pertenecía al estadio i de la GOLD vs. el 8,5% y presentaban mayor comorbilidad. Los pacientes del grupo 1 presentaban más agudizaciones, peor calidad de vida, mayor índice de BODEx 2,3 (1,8) vs. 1,1 (1,5). El 55,1% eran pacientes de alto riesgo (GoldC o Gold D). El diagnóstico antes de los 56 años, mayor tabaquismo, una FEV1 < 50% y una menor comorbilidad se asociaron a mayor probabilidad de EPOC con criterio LIN. Conclusión. El uso del LIN conforma 2 grupos de pacientes con características clínicas diferenciadas: Los sujetos con FEV1/FVC<0,7 y > LIN presentan menor grado de obstrucción, menor gravedad y más comorbilidad, lo que indica la posibilidad de sobrediagnóstico y sobretratamiento. La menor edad al diagnóstico, mayor tabaquismo y más obstrucción se asocian a ser EPOC con FEV1/FVC < 0,70 y ≤ LIN (grupo 1) (AU)

Aim. To evaluate the differences in COPD patients below the lower limit of normal (LLN) of the fixed ratio FEV1/FVC < 0.70 and those above this limit. Patients and methods. Cross-sectional study. COPD patients between 40 and 85 years old included in primary care clinical record database were randomly selected. Baseline and postbronchodilator spirometries were performed. Two groups of patients were established: FEV1/FVC<0.70 and ≤LIN (group1) and FEV/FVC<0.70 and >LIN (group 2). Sociodemographic, clinical, pulmonary obstruction, quality of life and attendance to health services variables were measured. The results of both groups were compared. Results. 22.3% of the subjects were misdiagnosed FEV1/FVC < 0,70. Patients in group 2 (FEV1/FVC<0.70 y > LLN) are diagnosed at an older age, they have a lower exposure to tobacco and better pulmonary function (FEV1: 74.9% vs 54.6%). 35.5% of those patients belong to stage i of GOLD, vs 8.5%, this patients have an increased comorbidity. Patients in group 1 have more COPD exacerbations, worse quality of life, a higher BODEx index 2,3 (1.8) vs 1.1 (1.5); 55.1% of those patients were high risk patients (GoldC or Gold D). Diagnose before being 56 years old, an increased exposure to tobacco, the FEV>50%, and a lower comorbidity are associated with a greater chance of suffering COPD with LLN criteria. Conclusion. We obtain two groups of patients with differentiated clinical characteristics if we use LLN. Subjects with FEV1/FVC<0.7 and >LLN have less obstruction, less severity and more comorbidity, suggesting the possibility of overdiagnosis or misdiagnosis. On the other hand, younger age at the time of diagnosis, higher tobacco consumption and more severe obstruction are related with FEV1/FVC >0.70 and

[Utility of normality low limit of spirometry in diagnosed COPD patients]. / Utilidad del límite inferior de normalidad de la espirometría en pacientes diagnosticados de EPOC.

AIM: To evaluate the differences in COPD patients below the lower limit of normal (LLN) of the fixed ratio FEV1/FVC < 0.70 and those above this limit. PATIENTS AND METHODS: Cross-sectional study. COPD patients between 40 and 85 years old included in primary care clinical record database were randomly selected. Baseline and postbronchodilator spirometries were performed. Two groups of patients were established: FEV1/FVC<0.70 and ≤LIN (group1) and FEV/FVC<0.70 and >LIN (group 2). Sociodemographic, clinical, pulmonary obstruction, quality of life and attendance to health services variables were measured. The results of both groups were compared. RESULTS: 22.3% of the subjects were misdiagnosed FEV1/FVC < 0,70. Patients in group 2 (FEV1/FVC<0.70 y > LLN) are diagnosed at an older age, they have a lower exposure to tobacco and better pulmonary function (FEV1: 74.9% vs 54.6%). 35.5% of those patients belong to stage i of GOLD, vs 8.5%, this patients have an increased comorbidity. Patients in group 1 have more COPD exacerbations, worse quality of life, a higher BODEx index 2,3 (1.8) vs 1.1 (1.5); 55.1% of those patients were high risk patients (GoldC or Gold D). Diagnose before being 56 years old, an increased exposure to tobacco, the FEV>50%, and a lower comorbidity are associated with a greater chance of suffering COPD with LLN criteria. CONCLUSION: We obtain two groups of patients with differentiated clinical characteristics if we use LLN. Subjects with FEV1/FVC<0.7 and >LLN have less obstruction, less severity and more comorbidity, suggesting the possibility of overdiagnosis or misdiagnosis. On the other hand, younger age at the time of diagnosis, higher tobacco consumption and more severe obstruction are related with FEV1/FVC >0.70 and

Primary Scarring Alopecia: Clinical-Pathological Review of 72 Cases and Review of the Literature.

PURPOSE OF THE STUDY: To analyze the epidemiologic, demographic, clinical, and histological characteristics of primary scarring alopecia (PSA) cases diagnosed over a 7-year period at the Department of Dermatology, Hospital Clinic, Barcelona, Spain. PROCEDURES: Seventy-two patients diagnosed with PSA between 2006 and 2012 were included. Age, sex, ethnic group, clinical pattern, predominant histological infiltrate, final clinical diagnosis, time of onset, treatments used, and clinical evolution were evaluated and correlated. RESULTS: The ethnic groups were distributed as follows: 93% European-Caucasian, 5% Mestizo-American, 1% oriental, and 1% Afro-American. Most cases were females (71%), and mean age was 51 ± 6 years. The follicular pattern was the most common, and the predominant inflammatory infiltrate was lymphocytic. Lichen planopilaris and frontal fibrosing alopecia were the main diagnoses. When correlating clinical aspects and histopathology, lymphocytic PSAs had a subacute onset and resulted in a nonchanging, more stable form, while neutrophilic PSAs had a more acute onset with an evolution of acute outbreaks. PSAs in a late stage with an absent/mild infiltrate had a subclinical onset and a slowly progressive or stable evolution. CONCLUSIONS: The PSAs are severe trichological conditions. Their high clinical and histopathological variability make them a diagnostic and therapeutic challenge. MESSAGE OF THE PAPER: Knowing the clinical and histopathological aspects of PSAs should be of crucial importance to the dermatologist.

Enfermedades metabólicas congénitas en un servicio de urgencias pediátricas / Inherited metabolic disorders in pediatric emergency services

Introducción: Los avances en el diagnóstico precoz y tratamiento han propiciado una mayor supervivencia, y en mejores condiciones, de los pacientes con enfermedades metabólicas congénitas (EMC). Estos pueden acudir a los Servicios de Urgencias Pediátricas (SUP) por motivos relacionados o no con su enfermedad. El propósito de este trabajo fue revisar las características de las visitas al SUP de estos pacientes, en un hospital de tercer nivel. Material y métodos: Se desarrolló un estudio observacional retrospectivo en el que se analizaron todas las visitas al SUP del Hospital Infantil La Paz durante los años 2011 y 2012 de pacientes con EMC. Se registraron el tipo de EMC, el motivo de consulta, el tiempo de evolución de los síntomas, la necesidad de ingreso hospitalario y la presencia de descompensación metabólica. Resultados: En total, fueron analizadas 107 visitas, siendo el motivo de consulta más frecuente los procesos respiratorios (30,8%). Cuando la consulta fue por vómitos, los pacientes con trastornos relacionados con las proteínas fueron los que menos tardaron en acudir al SUP. Un tercio de las visitas se siguió de ingreso, siendo la mitad de ellas por descompensación metabólica de la patología de base. Conclusiones: Los pacientes con EMC acudieron al SUP por motivos muy diversos, que en algunos casos fueron causa o consecuencia de una descompensación metabólica aguda que motivó el ingreso hospitalario. Al tratarse de enfermedades con baja prevalencia individual, resulta de interés contar con protocolos diagnóstico-terapéuticos que faciliten una atención óptima (AU)

Introduction: Advances in the early diagnosis and treatment have led to improved survival, and a better quality of life for patients with inherited metabolic disorders (IMD). They can go to the Pediatric Emergency Services (PES) for reasons unrelated to their disease. The purpose of this study was to review the characteristics of visitors to the PES of these patients in a tertiary hospital. Material and methods: A retrospective observational study was conducted on all visits from patients with IMD to the PES of Hospital Infantil La Paz over the years 2011 and 2012. IMD type, complaint, duration of symptoms, need for hospitalization, and presence of metabolic decompensation was recorded. Results: A total of 107 visits were analyzed, with the most frequent reason being for consultation of respiratory processes (30.8%). When the consultation was for vomiting, patients with protein-related disorders were those who delayed less in going to PES. One third of visitors were admitted, half of them due to metabolic decompensation of the underlying pathology. Conclusions: Patients with IMD came to PES for many different reasons, which in some cases were the cause or consequence of an acute metabolic decompensation that led to hospitalization. Being diseases with low prevalence, it would be useful to have diagnostic and therapeutic protocols in order to provide optimal care (AU)

[Inherited metabolic disorders in pediatric emergency services]. / Enfermedades metabólicas congénitas en un servicio de urgencias pediátricas.

INTRODUCTION: Advances in the early diagnosis and treatment have led to improved survival, and a better quality of life for patients with inherited metabolic disorders (IMD). They can go to the Pediatric Emergency Services (PES) for reasons unrelated to their disease. The purpose of this study was to review the characteristics of visitors to the PES of these patients in a tertiary hospital. MATERIAL AND METHODS: A retrospective observational study was conducted on all visits from patients with IMD to the PES of Hospital Infantil La Paz over the years 2011 and 2012. IMD type, complaint, duration of symptoms, need for hospitalization, and presence of metabolic decompensation was recorded. RESULTS: A total of 107 visits were analyzed, with the most frequent reason being for consultation of respiratory processes (30.8%). When the consultation was for vomiting, patients with protein-related disorders were those who delayed less in going to PES. One third of visitors were admitted, half of them due to metabolic decompensation of the underlying pathology. CONCLUSIONS: Patients with IMD came to PES for many different reasons, which in some cases were the cause or consequence of an acute metabolic decompensation that led to hospitalization. Being diseases with low prevalence, it would be useful to have diagnostic and therapeutic protocols in order to provide optimal care.

Etiología de la ataxia aguda en urgencias pediátricas: experiencia de 11 años / Etiology of acute ataxia in pediatric emergencies: 11 years experience

Las alteraciones en la marcha son un motivo de consulta habitual en las urgencias pediátricas; sin embargo, los casos de verdadera marcha atáxica son muy infrecuentes en los pacientes pediátricos. La principal preocupación del profesional de urgencias radica en excluir las causas graves de este síndrome clínico; afortunadamente, en la mayoría de casos en la infancia, su origen suele ser un proceso benigno y autolimitado. Dentro de las ataxias adquiridas, la forma más habitual de presentación en los servicios de urgencias suele ser la aguda, cuya evolución es menor de 72 horas en un niño previamente sano. En esta revisión hemos analizado los casos de ataxia adquirida valorados en nuestro servicio de urgencias pediátricas durante un periodo de 11 años, así como su enfoque diagnóstico. En nuestra serie, la causa más frecuente de ataxia aguda fue la postinfecciosa (un 39,13% del total), seguida de las de origen tumoral (17,39%) y las intoxicaciones (13,04%) (AU)

Changes in gait are a common reason for consultation in pediatric emergencies, however cases of true gait ataxia are rare in pediatric patients. The main concern of professional emergency lies in the exclusion of serious causes of this clinical syndrome, fortunately in most cases the origin in childhood is usually benign and self-limiting process. Among the acquired ataxias, the most common form of presentation in the pediatric emergency is usually that of acute ataxia, which are those whose evolution is less than 72 hours in a previously healthy child. In this review we have analyzed the cases of acquired ataxia evaluated in our pediatric emergency department during a period of 11 years and what was the diagnostic approach. In our series of cases the most common cause of acute ataxia was postinfectious (39.13% of total), followed by the tumoral origin (17.39%) and secondary to ingestion of toxic agents (13.04%) (AU)

Cefalea y dolor ocular en urgencias / Migraine and eye pain in the emergency department

No disponible

Abdominoplastia multifuncional en ancla: nuestra experiencia y nueva sistemática de abordaje en el paciente sin adelgazamiento / Multifunctional anchor shaping abdominoplasty: Our experience and new managing of the pacient without weight loss

La dermolipectomía multifuncional en ancla es una técnica efectiva en el tratamiento del contorno corporal en pacientes que han sufrido grandes pérdidas de peso. En la actualidad, en el sistema público de salud español, no es infrecuente que el cirujano plástico deba abordar pacientes en los que no ha habido adelgazamiento alguno y que más allá del contorno corporal, requieren una reparación de la pared abdominal. Los procedimientos reconstructivos de la pared abdominal no están reñidos con una bordaje simultáneo del contorno corporal para una mejora funcional y de la calidad de vida del paciente. Exponemos nuestra experiencia con este conocido patrón de dermolipectomía en 32 casos, en los que mostramos el abordaje hecho en 3 pacientes con ausencia o fracaso en el adelgazamiento. El gran volumen intrabdominal, graso y visceral, de estos pacientes sin adelgazamiento, conlleva que puedan presentar complicaciones por alteración en la relación continente-contenido abdominal tras grandes dermolipectomías; las más frecuentes son dehiscencia de sutura, necrosis de los colgajos, alteraciones respiratorias o cierre a tensión que en último término puede desencadenar un síndrome compartimental intrabdominal. La adaptación y fisioterapia respiratoria preoperatoria del enfermo, el diseño de colgajos suprapúbicos que eviten el cierre a tensión en el punto de unión de las suturas, el no despegamiento de los colgajos y la estimación de la presión intrabdominal intraoperatoria, permiten ampliar la indicación de este patrón de dermolipectomía a pacientes en los que no ha habido adelgazamiento (AU)

Multifunctional anchor dermolipectomy has been aproved effective technique in the treatment of body contouring in patients who have suffered great loss of weight. Currently, in Spanish public health system, are not uncommon for the plastic surgeon patients who have not lost enough weight, and beyond any body contour procedure require repair of the abdominal wall. As other authors describe, reconstructive procedures of the abdominal wall can be practised with a simultaneous approach of body contour, resulting in a patients´ functional improvement and better quality of life. We present our experience with this dermolipectomy pattern in 32 cases and we show our managing of 3 patients with no weight loss. The large intrabdominal volume, visceral and fatty in these patients without weight loss, involves complications that may result in alterations of the container-contained relation ship after major abdominal surgery. The most common ones are suture dehiscence, flap necrosis, respiratory failure or stress closure that ultimately may result in an intra-abdominal compartimental syndrome. Respiratory fisiotherapy and preoperative chest physiotherapy, suprapubic flap design to prevent the closurestress or non-stripping of the flaps and the measure of the stimative intraoperative intra-abdominal pressure can extend indication of this abdominoplasty pattern inpatients in which there has been no thinning (AU)

Cuerpos extraños como causa de metrorragia posmenopáusica / No disponible

Presentamos dos casos clínicos de mujeres mayores (68 y 91 años) que fueron remitidas al Servicio de Ginecología desde Atención Primaria por presentar metrorragia posmenopáusica. La exploración demostró la presencia de cuerpos extraños vaginales: un capuchón plástico de un preparado farmacológico de aplicación vaginal en el primer caso y la tapa de una barra de labios en el segundo (AU)

We present two clinical cases of a 68 and a 91-year-oldwoman who were sent to the Gynecology Department by their General Practitioners because they presented posmenopausal bleeding. The examination showed the presence of vaginal foreign bodies: a plastic cover from a pharmacologic product for vaginal use in the first case and a lipstick bar in the second (AU)

Grado de conocimiento y cumplimiento terapéutico, y prevalencia de los problemasrelacionados con los medicamentosen mayores de 70 años en una zona básicade salud / Knowledge level and adherence to the treatments and prevalence of drug related problems in persons over 70 years in a Basic Health Zone

Objetivos: Estimar la utilización racional y responsable de los medicamentos como herramienta terapéutica y/o preventiva. Método: Estudio descriptivo y transversal, realizado mediante entrevista personal en el domicilio, a 400 mayores de 70 años en una zona básica de salud. Resultados: Se realizaron 400 entrevistas domiciliarias al75,4% de la población (media de edad de 78,26 años en los varones y de 78,47 en las mujeres). Un 95,25% declara consumir más de un medicamento (media de 7,63 especialidades por persona). Los grupos J, R, D y S son los que presentan mayor grado de desconocimiento y falta de cumplimiento terapéutico. El desconocimiento aumenta con la edad, y la falta de cumplimiento se mantiene constante. La población beneficiaria del servicio de ayuda domiciliaria expresa un mayor desconocimiento, aunque un menor incumplimiento terapéutico. Se detectan 174 problemas de salud relacionados con medicamentos(PRM) en 133 pacientes. Un 71,26% de los PRM detectados son de efectividad y un 8,5% son reacciones adversas a medicamentos. Los pacientes con PRM tomaban una media de 8,32 medicamentos, frente a 6,73 en los que no se detectaban PRM. Se repartieron sistemas personalizados de dosificación al 12,8%(intervalo de confianza del 95%: 12,8 ± 3) de los pacientes que, generalmente, mostraban un desconocimiento muy importante con respecto a la media. Conclusiones:1. El desconocimiento de los tratamientos en las personas mayores de 70 años es directamente proporcional a la edad, aunque con gran variabilidad. El cumplimiento terapéutico no depende de este factor.2. Existe una elevada prevalencia de PRM en este grupo de población, relacionados claramente con el nivel de polimedicación.3. La educación en salud de la población con llevaría un mayor grado de conocimiento y, por tanto, una mayor efectividad y menos PRM (AU)

Objectives: Estimate the rational and responsible use of drugs as a therapeutic and/or preventive tool. Method: Descriptive and transversal study, through personalinter views conducted at home, of 400 70-year-old- persons, in a ZBS. Results: 400 interviews were conducted, 75.4% of the population (average age of 78.26 year-old for men and 78.47 for women).A 95.25% declare consuming more than one drug (average of specialties: 7.63 per person). The groups with greatest ignorance and lack of adherence are the J, R, D and S. Ignorance increases with age, non-adherence remains constant. The target population of ODS expresses a greater ignorance but a minor therapeutic non-compliance. 174 Drug Related Problems (DRP) were detected in 133 patients. A 71.26% of the DRP detected are effective and 8.5% are Adverse Drug Reactions. Patients with DRP took an average of 8.32 medications, versus6.73 for those without DRP.SPD were distributed to 12.8% (95%: 12.8 ± 3) of the patients, who generally showed a very important ignorance as regards the average.Conclusions1. Ignorance of the treatments at the age of 70 is directly proportional to age, with great variability. The therapeutic adherence does not depend on this factor.2. There is a high prevalence of PRM in this population group, clearly linked to the level of polypharmacy 3. Health education of the population implies a better knowledge and, consequently, a greater efficiency and fewer problems with medication (AU)

Función social, deterioro cognitivo,discapacidad y autopercepción de la salud en mayores de 70 años en una zona básica de salud, e influencia de estos factores en el consumo de medicamentos / Social function, cognitive decline, disability and self-perceived health status

Objetivos: Conocer el nivel de salud y la calidad de vida relacionada con la salud (CVRS) de los mayores de 70 años en una zona básica de salud (ZBS) y la influencia de estos factores en el consumo de medicamentos. Método: Estudio transversal realizado mediante entrevista personal en el domicilio, a mayores de 70 años en una ZBS. Resultados: Se realizaron 400 entrevistas domiciliarias (75,4% de la población) (media de edad: 78,26 años en los hombres y78,47 años en las mujeres). Un 24,5% de los participantes está moderadamente incapacitado socialmente, un 6,4% se encuentra gravemente incapacitado socialmente, y 9 personas (2,3%) estaban totalmente incapacitadas socialmente. Un 19,5% (intervalo de confianza [IC] del 95%: 19,5 ± 4) padece una limitación funcional moderada, y un 14% (IC 95%: 14 ± 3) una limitación funcional severa; además, un 7% (IC del 95%: 2,2 ± 1) requiere total supervisión por parte de sus cuidadores. Existe relación entre la función social y el nivel de limitación funcional. Cuanto menores la limitación funcional, mejor puntuación se obtiene en recursos sociales (p= 0,005). En salud autopercibida, un 28,75% (IC del95%: 28,75 ± 4) expresa que su salud es regular, y un 7% (IC del 95%: 7 ± 3) que su salud es mala. Cuanto mayor es el consumo de medicamentos, peor es la autovaloración de la salud.Conclusiones: ·Existe una relación inversa entre el consumo de medicamentos y la autovaloración de la salud. ·La sensibilidad al dolor es elevada en la mayoría de la población, y es mayor en las mujeres que en los hombres. ·Existe una clara correlación entre la función social y la limitación funcional; a medida que la limitación funcional disminuye, también se reducen los niveles de función social. ·La soledad resulta ser el problema más prevalente en este grupo de edad (AU)

Objective: To determine the health status and the health-related quality of life (HRQL) of people over 70 years age in a basic health area (BHA) and the influence of these factors on the consumption of drugs. Method: Cross-sectional study carried out by means of personal home interviews with people aged 70 years and over in a BHA. Results: Four hundred home interviews were carried out(75.4% of the population) (average age, 78.26 years for men and 78.47 years for women). In all, 24.5% of these people have a moderate social disability, 6.4% have a severe social disability, and 9 people (2.3%) are totally disabled insocial terms. In 19.5% (95% CI: 19.5 ± 4) a moderate functional limitation was observed, and 14.0% (95% CI: 14.0 ± 3)have a severe functional limitation; in addition, 7% (95% CI:2.2 ± 1) require total supervision by their caregivers. There is a relationship between the social function and the level of functional limitation. The lower the degree of their functional limitation, the higher the score in social resources (p =0.005). In terms of quality of life, 28.75% (95% CI: 28.75 ± 4)state that their health is fair and 7% (95%: CI 7 ± 3) state that their health is poor. The greater the consumption of drugs, the worse their self-perceived health status. Conclusions: ·There is an inverse relationship between consumption of drugs and self-evaluation of health status.·The sensitivity to pain is high in most of the population, and is greater in women than in men. ·There is a clear correlation between the social function and functional limitation; as the functional limitation becomes more severe, the levels of social function also diminish. ·Loneliness is the most prevalent problem in this age group (AU)

[Symptomatic secondary hyponatraemia due to combined treatment anticonvulsant and antidepressant: risk of sudden death in epilepsy?]. / Hiponatremia sintomática secundaria a tratamiento conjunto anticomicial y antidepresivo: ¿riesgo de muerte súbita en epilepsia?

The notable incidence of epilepsy in the general population, with the presence, more and more frequent of refractory therapeutic, it forces the anticonvulsant polytherapy. If we depart from the fact, that many of the epilepsies have a secondary cause, with affective disorders associate, we can understand the most habitual association of anticonvulsant and antidepressant. We present the clinical case of a 37-year-old-woman with refractory therapeutic epilepsy associated to exogenous depressive syndrome, in combined treatment with Carbamazepine, Lamotrigine and Venlafaxine, that suffers a episode of syncope secondary to symptomatic hyponatraemia, generated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The relevance of this case resides in the fact that the hyponatraemia generated by this pharmacological combination, up to now, it has not been described in the literature. This electrolytic anomaly can derive in secondary neurological and cardiovascular effects, in so outstanding occasions, as to produce the phenomenon denominated sudden death in the epileptic patient (SUDEP). We recommended a strict ionic control in those patients that require anti-epileptic and anti-depressant treatment combined, in order to avoiding paroxistic vascular episodes and to minimize the risk of SUDEP.