Conceptos y percepciones acerca del diagnóstico y tratamiento de la fibromialgia en un grupo de médicos especialistas en medicina física y rehabilitación en Colombia / Beliefs and perceptions of the diagnosis and treatment of fibromyalgia in a group of rehabilitation and physical medicine specialists in Colombia

INTRODUCCIÓN: La fibromialgia es una enfermedad crónica caracterizada por la presencia de dolor musculoesquelético, usualmente asociada a otros síntomas como depresión, fatiga y trastornos del sueño, entre otros. Los conceptos y las percepciones sobre el diagnóstico y el tratamiento de la fibromialgia, entre los médicos especialistas en medicina física y rehabilitación, no se conocen objetivamente. El propósito de este estudio es describir los conceptos y percepciones sobre el diagnóstico y tratamiento de la fibromialgia entre un grupo de especialistas en medicina física y rehabilitación en Colombia. MÉTODOS: Estudio descriptivo de corte transversal. A través de un grupo focal en el que participaron 2 reumatólogos, un especialista en medicina física y rehabilitación y un experto en métodos de investigación cualitativa, se diseñó una encuesta para evaluar las percepciones y conceptos que los especialistas en medicina física y rehabilitación tienen sobre el diagnóstico y el tratamiento de la fibromialgia. La encuesta se aplicó de forma autoadministrada y anónima durante las reuniones de la Asociación Colombiana de Medicina Física y Rehabilitación. RESULTADOS: Encuesta aplicada a 99 médicos especialistas en medicina física y rehabilitación. El 17,1% (n=17) de los médicos no cree que haya suficiente evidencia para considerar la fibromialgia como una enfermedad, el 86,8% (n=86) usa criterios ACR de 1990 para diagnosticar pacientes con fibromialgia y el 33,3% (n=33) manifestó emplear los criterios de clasificación de 2010. Los medicamentos más formulados para el manejo de la fibromialgia son los antidepresivos, prescritos por el 84,8% de los encuestados, seguidos de analgésicos (75,7%) y anticonvulsivantes (66,6%). En cuanto al manejo multidisciplinario, se encontró que el 50,6% de los médicos rehabilitadores remite estos pacientes a reumatología y el 40,7% a psiquiatría. El 77,2% de los médicos rehabilitadores considera que el paciente con fibromialgia debe ser manejado por su especialidad. CONCLUSIÓN: El presente estudio muestra información acerca de las percepciones sobre el diagnóstico y tratamiento de la fibromialgia entre un grupo de médicos rehabilitadores colombianos, documentándose un frecuente uso de los criterios de clasificación ACR 1990. En cuanto al tratamiento, se observa un alto porcentaje de uso de medicamentos, en especial antidepresivos y analgésicos. La mayoría de los médicos rehabilitadores considera que debe ser el tratante del paciente con fibromialgia

INTRODUCTION: Fibromyalgia is a chronic disease characterised by the presence of musculoskeletal pain, usually associated with other symptoms, including depression, fatigue, and sleep disorders. There is no objective information on the beliefs and perceptions of the diagnosis and treatment of fibromyalgia among rehabilitation and physical medicine specialists. The aim of this study was to describe these beliefs and perceptions among a group of physical medicine and rehabilitation specialists in Colombia. METHODS: We performed a cross-sectional study. A focus group was held with the participation of 2 rheumatologists, one physical medicine and rehabilitation specialist and an expert in qualitative research. The group designed a survey to assess the beliefs and perceptions of physical medicine and rehabilitation specialists of the diagnosis and treatment of fibromyalgia. The self-administered, anonymous questionnaire was completed during meetings of the Colombian Association of Physical Medicine and Rehabilitation. RESULTS: The questionnaire was completed by 99 physical medicine and rehabilitation specialists. Of these, 17.1% (n=17) believed there was insufficient evidence to consider fibromyalgia a disease, 86.8% (n=86) used the ACR 1990 criteria to diagnose patients with fibromyalgia, and 33.3% (n=33) used the criteria of the 2010 classification. The most commonly used drugs for the management of fibromyalgia were antidepressants, prescribed by 84.8% of the surveyed physicians, followed by analgesics (75.7%) and anticonvulsants (66.6%). Concerning multidisciplinary management, 50.6% referred these patients to a rheumatologist and 40.7% to a psychiatrist. In all, 77.2% of rehabilitation specialists believed that patients with fibromyalgia should be managed by their specialty. CONCLUSION: This study provides information on perceptions of the diagnosis and treatment of fibromyalgia among a group of Colombian rehabilitation specialists and found frequent use of the ACR 1990 classification. Among these physicians, the use of drugs, especially antidepressants and analgesics, was high. Most believed that patients with fibromyalgia should be treated by rehabilitation specialists

La opinión de los profesionales sanitarios sobre la presencia de familiares durante las maniobras de resucitación cardiopulmonar / The opinion of health professionals regarding the presence of relatives during cardiopulmonary resucitation

Introducción: Las últimas recomendaciones de la American Heart Association y de la European Resuscitation Council invitan a permitir la presencia de familiares (PF) durante la resucitación cardiopulmonar (RCP) como un cuidado familiar más. Objetivo: Conocer la opinión de los profesionales sanitarios sobre la PF durante las maniobras de RCP. Método: Estudio observacional descriptivo transversal realizado a través de una encuesta online en España, elaborada con muestreo no probabilístico (n=315). Resultados: El 45% cree que la PF durante la RCP no es una demanda de los usuarios. El 64% valora de forma negativa o muy negativa la implantación de esta práctica. El 45% opina que evitaría el sentimiento de abandono que se instala en los allegados, siendo este el beneficio potencial más percibido. El 30% no cree que pueda ayudar a reducir la ansiedad de los familiares. La mayoría señala que la PF provocaría situaciones de violencia, daño psicológico en los testigos y más errores durante la atención. El 48% se siente preparado para desempeñar el papel de acompañante. Conclusiones: La mayoría de los profesionales percibe más riesgos que beneficios, mostrándose desfavorables a permitir la PF debido a una actitud paternalista y al miedo a las reacciones que estos pudieran presentar hacia el equipo. El personal de Urgencias y Emergencias extrahospitalarias parece el colectivo más abierto a permitir esta práctica. La mayoría de los profesionales no se sienten del todo preparados para desempeñar el papel de acompañante (AU)

Background: The latest recommendations from the American Heart Association and the European Resuscitation Council invite allowance for the presence of relatives (PR) during cardiopulmonary resuscitation (CPR) as an extra measure of family care. Objective: To discover the opinion of health professionals on the PR during CPR. Method: Cross-sectional observational study through an online survey in Spain, based on a non-probability sample (n=315). Results: 45% consider that the PR during CPR is not demanded by users. 64% value the implementation of this practice in a negative or a very negative way. 45% believe that the practice would avoid the feeling of abandonment that is instilled in the relatives, this being the most widely perceived potential benefit. 30% do not believe that it can help reduce the anxiety of relatives. The majority remarked that PR would cause situations of violence, psychological harm in witnesses, and more mistakes during care. 48% feel prepared to perform the role of companion. Conclusions: Most professionals perceive more risks than benefits, and are not in favour of allowing PR due to a paternalistic attitude, and fear of the reactions that could be presented to the team. Extra-hospital emergency personnel seems to be the group most open to allowing this practice. Most professionals do not feel fully prepared to perform the role of companion (AU)

Key issues in hymenoptera venom allergy: an update

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis (AU)

En esta revisión el Comité de Alergia a Himenópteros de la SEAIC ha analizado la literatura científica más reciente sobre los principales problemas diagnósticos de la alergia a himenópteros, así como sobre las dificultades que pueden surgir durante la inmunoterapia con venenos. Se revisan especialmente las novedades relacionadas con el diagnóstico molecular y los perfiles moleculares de riesgo. También se describe la alergia a himenópteros poco habituales y los problemas diagnósticos y terapéuticos que esta conlleva. Por último, se tratan los síndromes de activación mastocitaria clonal, íntimamente relacionados con la alergia a himenópteros, que se han convertido en un nuevo reto diagnóstico para el alergólogo (AU)

Biochemical and biological characterization of Bothriechis schlegelii snake venoms from Colombia and Costa Rica

Snakebites inflicted by the arboreal viperid snake Bothriechis schlegelii in humans are characterized by pain, edema, and ecchymosis at the site of the bite, rarely with blisters, local necrosis, or defibrination. Herein, a comparative study of Bothriechis schlegelii snake venoms from Colombia (BsCo) and Costa Rica (BsCR) was carried out in order to compare their main activities and to verify the efficacy of Bothrops antivenom produced in Brazil to neutralize them. Biochemical (SDS-PAGE and zymography) and biological parameters (edematogenic, lethal, hemorrhagic, nociceptive, and phospholipase A(2) activities) induced by BsCo and BsCR snake venoms were evaluated. The presence of antibodies in Bothrops antivenom that recognize BsCo and BsCR snake venoms by enzyme-linked immunosorbent assay and Western blotting, as well as the ability of this antivenom to neutralize the toxic activities were also verified. SDS-PAGE showed differences between venoms. Distinctive caseinolytic and hyaluronidase patterns were detected by zymography. BsCo and BsCR showed similar phospholipase A(2) activity. Strong cross-reactivity between BsCo and BsCR was detected using Bothrops antivenom with many components located between 150 and 35kDa. BsCR was more edematogenic and almost fourfold more hemorrhagic than BsCo, and both venoms induced nociception. BsCR (LD50 5.60mg/kg) was more lethal to mice than BsCo (LD50 9.24mg/kg). Bothrops antivenom was effective in the neutralization of lethal and hemorrhagic activities of BsCo and BsCR and was partially effective in the neutralization of edematogenic and nociceptive activities. In conclusion, geographic distribution influences the composition and activities of Bothriechis schlegelii venoms. Bothrops antivenom cross-reacted with these venoms and was partially effective in neutralizing some toxic activities of BsCo and BsCR

Combined venomics, venom gland transcriptomics, bioactivities, and antivenomics of two Bothrops jararaca populations from geographic isolated regions within the Brazilian Atlantic rainforest

Bothrops jararaca is a slender and semi-arboreal medically relevant pit viper species endemic to tropical and subtropical forests in southern Brazil, Paraguay, and northern Argentina (Misiones). Within its geographic range, it is often abundant and is an important cause of snakebite. Although no subspecies are currently recognized, geographic analyses have revealed the existence of two well-supported B. jararaca clades that diverged during the Pliocene similar to 3.8 Mya and currently display a southeastern (SE) and a southern (S) Atlantic rainforest (Mata Atlantica) distribution. The spectrum, geographic variability, and ontogenetic changes of the venom proteomes of snakes from these two B. jararaca phylogroups were investigated applying a combined venom gland transcriptomic and venomic analysis. Comparisons of the venom proteomes and transcriptomes of B. jararaca from the SE and S geographic regions revealed notable interpopulational variability that may be due to the different levels of population-specific transcriptional regulation, including, in the case of the southern population, a marked ontogenetic venom compositional change involving the upregulation of the myotoxic PLA(2) homolog, bothropstoxin-l. This population-specific marker can be used to estimate the proportion of venom from the southern population present in the B. jararaca venom pool used for the Brazilian soro antibotropico (SAB) antivenom production. On the other hand, the southeastern population-specific D49-PLA(2) molecules, BinTX-I and BinTX-II, lend support to the notion that the mainland ancestor of Bothrops insularis was originated within the same population that gave rise to the current SE B. jararaca phylogroup, and that this insular species endemic to Queimada Grande Island (Brazil) expresses a pedomorphic venom phenotype. Mirroring their compositional divergence, the two geographic B. jararaca venom pools showed distinct bioactivity profiles. However, the SAB antivenom manufactured in Vital Brazil Institute neutralized the lethal effect of both venoms to a similar extent. In addition, immobilized SAB antivenom immunocaptured most of the venom components of the venoms of both B. jararaca populations, but did not show immunoreactivity against vasoactive peptides. The Costa Rican bothropic-crotalic-lachesic (BCL) antivenom showed the same lack of reactivity against vasoactive peptides but, in addition, was less efficient immunocapturing PI- and PIII-SVMPs from the SE venom, and bothropstoxin-I, a CRISP molecule, and a D49-PLA(2) from the venom of the southern B. jararaca phylogroup. The remarkable paraspecificity exhibited by the Brazilian and the Costa Rican antivenoms indicates large immunoreactive epitope conservation across the natural history of Bothrops, a genus that has its roots in the middle Miocene. This article is part of a Special Issue entitled: Omics Evolutionary Ecolog. (C) 2015 Elsevier B.V. All rights reserved.

Lemnitoxin, the major component of Micrurus lemniscatus coral snake venom, is a myotoxic and pro-inflammatory phospholipase A(2)

The venom of Micrurus lemniscatus, a coral snake of wide geographical distribution in South America, was fractionated by reverse-phase HPLC and the fractions screened for phospholipase A(2) (PLA(2)) activity. The major component of the venom, a PLA(2), here referred to as 'Lemnitoxin', was isolated and characterized biochemically and toxicologically. It induces myotoxicity upon intramuscular or intravenous injection into mice. The amino acid residues Arg15, Ala100, Asn108, and a hydrophobic residue at position 109, which are characteristic of myotoxic class I phospholipases A(2), are present in Lemnitoxin. This PLA(2) is antigenically related to M. nigrocinctus nigroxin, Notechis scutatus notexin, Pseudechis australis mulgotoxin, and Pseudonaja textilis textilotoxin, as demonstrated with monoclonal and polyclonal antibodies. Lemnitoxin is highly selective in its targeting of cells, being cytotoxic for differentiated myotubes in vitro and muscle fibers in vivo, but not for undifferentiated myoblasts or endothelial cells. Lemnitoxin is not lethal after intravenous injection at doses up to 2 mu g/g in mice, evidencing its lack of significant neurotoxicity. Lemnitoxin displays anticoagulant effect on human plasma and proinflammatory activity also, as it induces paw edema and mast cell degranulation. Thus, the results of this work demonstrate that Lemnitoxin is a potent myotoxic and proinflammatory class I PLA(2). (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Alergia a la oruga procesionaria del pino / Allergy to pine processionary moth larvae

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Abordaje mínimamente invasivo del ureterocele en pacientes con duplicidad renoureteral / Endoscopic incision of intravesical ureteroceles in patients with duplex system

Objetivo. Evaluar la situación clínica y la función renal de pacientes con duplicidad renoureteral y ureterocele tras su drenaje mediante cistoscopia. Material y métodos. En 9 pacientes diagnosticados de duplicidad renoureteral se realizó drenaje del ureterocele por presentar infecciones urinarias de repetición (7 niños con episodios de pielonefritis y sepsis) u obstrucción del drenaje urinario. La media de edad fue de 33 meses (rango 8-108 meses). La punción del ureterocele se realizó con anestesia general, en quirófano mediante cistouretroscopia con electrodo en asa. El tiempo mínimo de seguimiento fue de 12 meses (rango 12-48 meses) e incluye ecografía renal, estudio isotópico renal MAG 3 confurosemida y, en los casos con reflujo vesicoureteral preoperatorio o infección urinaria postoperatoria, estudio con ecocistografía. Resultados. El tiempo medio operatorio fue de 60 minutos. La estancia media hospitalaria fue de 48 horas. No se presentaron complicaciones durante la técnica. En cinco pacientes desparecieron los episodios de infección urinaria. La ecografía demostró la disminución de la hidronefrosis y del megauréter. En dos pacientes mejoró la función renal diferencial (FRD). Un paciente con FRD preoperatoria del 14% precisó nefrectomía. Un paciente presentó reflujo vesicoureteral postoperatorio. Conclusiones. El drenaje del ureterocele en pacientes con duplicidad renoureteral reduce los episodios de infección urinaria y la dilatación de la vía urinaria

Purpose. To evaluate the clinical status and renal function of patients with duplex system and intravesical ureterocele after drainage by cystoscopy. Material and methods. In 9 patients with duplex system and intravesical ureterocele drainage was performed to present recurrent urinarytract infections (7 children with episodes of pyelonephritis and sepsis) or obstruction of the urinary drainage. The mean age was 33 months (range 8-108 months). The technique was done under general anesthesia in the operating room and puncture of the ureterocele was performed using cystourethroscopy with loop electrode. The minimum follow-up was 12 months (range 12-48 months) and includes renal ultrasound, renal isotopic study (Mag 3 with furosemide) and echocystography study in patients with preoperative vesicoureteral reflux or postoperative urinary tract infection. Results. The average operative time was 60 minutes. Mean hospital stay was 48 hours. There were no complications during the procedure. In five patients urinary infection episodes disappeared. Ultrasound demonstrated decreased hydronephrosis and megaureter. In two patients the differential renal function following the technique improved. One patient with preoperative split renal function of 14% required nephrectomy. One patient had postoperative vesicoureteral reflux. Conclusions. The drainage of intravesical ureterocele in patients with duplex system reduces episodes of urinary tract infection and urinary tract dilation

Relación entre la personalidad y la presencia de sobrepeso- obesidad en niños y adolescentes / Relationship between personality and the presence of overweight-obesity in children and adolescents

La obesidad representa un importante problema de salud pública en el mundo de características epidémicas. Existe una relación entre el sobrepeso-obesidad en la población infanto-juvenil y la presencia de psicopatología en la que interviene la personalidad. Este estudio descriptivo intenta caracterizar y encontrar relaciones entre dimensiones y perfiles psicopatológicos de personalidad y sobrepeso-obesidad en niños de 9-14 años atendidos en Pediatría. Se utiliza el Inventario Infanto Juvenil de Temperamento y Carácter de Cloninger (JTCI), basado en el inventario original de Cloninger, para estudiar la personalidad, junto con la recogida de información sociodemográfica, clínica, antropométrica y académica. Se emplean técnicas estadísticas descriptivas y análisis multivariante de regresión logística. Las dimensiones dependencia de la recompensa, fantasía y evitación del daño presentan los valores más extremos, no mostrando perfiles psicopatológicos el 93% de la muestra. El perfil psicopatológico relacionado con los trastornos por déficit de atención con/sin hiperactividad y bipolar (TDAH/BP) es el más frecuente. El perfil TDAH/BP presenta un Índice de Masa Corporal (IMC) significativamente superior al resto. Ser hombre y repetir curso incrementan el riesgo de padecer sobrepeso-obesidad, mientras el aumento de edad y la dimensión persistencia se comportan como factores protectores en el análisis multivariante. Es necesario comprender mejor la relación entre personalidad y sobrepeso-obesidad en la infancia y adolescencia para identificar terapias más efectivas

Obesity is a major public health problem in the world of epidemic proportions. There is a relationship between overweight-obesity in the pediatric population and the presence of psychopathology where personality is involved. This descriptive study attempts to characterize and find relationships between dimensions and psychopathological personality profiles and overweight-obesity in children 9-14 years treated in Pediatrics. Junior Temperament and Character Inventory of Cloninger (JTCI), instrument based on the original inventory of Cloninger, is used to study personality along with sociodemographic, clinical, anthropometric and academic information collection. Descriptive statistics and multivariate logistic regression analysis techniques are used. The dimensions reward dependence, fantasy and harm avoidance have the most extreme values, showing no psychopathological profiles 93% of the sample. Psychopathological profile associated with Attention deficit hyperactivity disorder and Bipolar disorder (ADHD/BP) is the most common. ADHD/BP profile has a Body Mass Index (BMI) significantly higher than the rest. Being male and repeat course increases the risk of overweight-obesity, while increasing age and persistence dimension behave as protective factors in the multivariate analysis. A better understanding of the relationship between personality and overweight-obesity in children and adolescents to identify more effective therapies is needed

PillCam© Colon Capsule for the study of colonic pathology in clinical practice. Study of agreement with colonoscopy

Introduction: several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology. Aims and methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed. Results: a total of 144 subjects (67 women and 77 men); (52.17±16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified. In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4 %. The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn´s Disease in 9 and ulcerative colitis in other 8 cases. Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agree - ment with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data(AU)