ABSTRACT
OBJECTIVES: To evaluate the association between low back pain (LBP) and painful temporomandibular disorders (TMDs). METHODS: Systematic review of observational studies. Searches were conducted using OVID MEDLINE, CINHAL, Web of Science and PUBMED databases up to 21 October 2022. Qualitative and quantitative analyses were performed. Risk of bias (RoB) was assessed using the Quality in Prognosis Studies tool (QUIPS). RESULTS: Eight studies were included in the present review with meta-analysis. The first onset of TMDs was more likely in patients with previous chronic LBP (hazard ratio (HR) 1.53 [95% confidence interval (CI): 1.28; 1.83, p < .00001]). In addition, patients with chronic LBP had 3.25 times the odds (OR) [95% CI: 1.94; 5.43, p < .00001] of having chronic TMDs than those who did not have chronic LBP. In addition, the higher the exposure to chronic LBP, the higher the risk of developing a first onset of TMDs. CONCLUSIONS: Chronic LBP can be considered a risk/contributing factor for painful TMDs. Although there is a high certainty in the evidence linking chronic LBP with the risk of a first onset of TMDs, there are insufficient studies to draw definitive conclusions. Furthermore, while an association between chronic LBP and chronic TMDs and a dose-effect was observed between these two conditions, a limited number of studies and evidence exist to support these findings. Future studies are needed to increase the body of evidence.
Subject(s)
Low Back Pain , Temporomandibular Joint Disorders , Humans , Chronic Disease , Low Back Pain/complications , Prognosis , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/epidemiology , Observational Studies as TopicABSTRACT
OBJETIVO: Estudiar si la ampliación, a festivos y fines de semana, del protocolo de detección proactiva precoz de gravedad en el hospital y actuación de intensivistas en planta convencional y urgencias (actividad «UCI sin paredes») se asocia a una reducción en la mortalidad de los pacientes ingresados en UCI en esos días. DISEÑO: Estudio cuasi experimental before-after. ÁMBITO: Hospital de nivel 2 con 210 camas en funcionamiento y UCI polivalente con 8 camas. PACIENTES O PARTICIPANTES: En el grupo control, donde no se realiza la actividad «UCI sin paredes» los fines de semana ni festivos, se incluyeron los pacientes ingresados en la UCI esos días del 1 de enero de 2010 al 30 de abril de 2013. En el grupo intervención se amplió la actividad «UCI sin paredes» a los fines de semana y festivos y se incluyeron los pacientes ingresados esos días del 1 de mayo de 2013 al 31 de octubre de 2014. Se excluyeron los pacientes procedentes de quirófano tras una cirugía programada. Variables de interés: Se analizaron las variables demográficas (edad, sexo), la procedencia (urgencias, planta de hospitalización, quirófano), el tipo de paciente (médico, quirúrgico), el motivo de ingreso, las comorbilidades y el SAPS 3 como puntuación de gravedad al ingreso, estancia en UCI y hospitalaria, además de la mortalidad en la UCI y en el hospital. RESULTADOS: Se incluyeron en el grupo control 389 pacientes, y 161 en el grupo intervención. No se encontraron diferencias entre ambos grupos, salvo en la comorbilidad cardiovascular (un 49% en el grupo control frente a un 33% en el grupo intervención; p < 0,001), en la gravedad al ingreso medida mediante el SAPS 3 (mediana de 52 [percentiles 25-75: 42-63] en el grupo control frente a 48 [percentiles 25-75: 40-56] en el grupo intervención; p= 0,008) y en la mortalidad en UCI, que fue de un 11% en el grupo control (IC 95% 8 a 14) frente al 3% (IC 95% 1 a 7) en el grupo intervención (p = 0,003). En el análisis multivariable, los 2 únicos factores asociados con la mortalidad en UCI fueron: SAPS 3 (OR 1,08; IC 95% 1,06-1,11) y el pertenecer al grupo intervención (OR 0,33; IC 95% 0,12-0,89). CONCLUSIONES: La ampliación de la actividad «UCI sin paredes» a los fines de semana y festivos conlleva un descenso en la mortalidad en la UCI
OBJECTIVE: To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital («ICU without walls» project) results in decreased mortality among patients admitted to the ICU during those days. DESIGN: A quasi-experimental before-after study was carried out. SETTING: A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds. PATIENTS OR PARTICIPANTS: The control group involved no «ICU without walls» activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the «ICU without walls» activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded. Variables of interest: An analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital. RESULTS: A total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P < .001), severity upon admission (median SAPS 3 score 52 [percentiles 25-75: 42-63) in the control group versus 48 [percentiles 25-75: 40-56] in the intervention group; P = .008) and mortality in the ICU (11% in the control group [95% CI 8-14] versus 3% [95% CI 1-7] in the intervention group; P = .003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06-1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12-0.89). CONCLUSIONS: Extension of the «ICU without walls» activity to holidays and weekends results in a decrease in mortality in the ICU
Subject(s)
Humans , Critical Illness/mortality , Severity of Illness Index , Decision Support Techniques , Critical Care/organization & administration , Intensive Care Units/organization & administration , Early Diagnosis , Evaluation of the Efficacy-Effectiveness of Interventions , Case-Control StudiesABSTRACT
OBJETIVO: Evaluar la repercusión del momento de ingreso en UCI sobre el pronóstico de los pacientes. DISEÑO: Estudio de cohorte prospectivo, observacional y no intervencionista. Se consideró on-hours el turno de mañana y tarde de los días laborables y off-hours el resto de los turnos. ÁMBITO: Hospital de nivel 2 con 210 camas en funcionamiento y UCI polivalente con 8 camas. PACIENTES O PARTICIPANTES: Todos los pacientes que ingresaron en la UCI durante 3 años, de enero de 2010 a diciembre de 2012, excluyendo aquellos pacientes procedentes de quirófano tras una cirugía programada. Los pacientes se estratificaron en 2 grupos en función de que el momento de ingreso fuera on-hours u off-hours. Intervenciones: Estudio no intervencionista. VARIABLES DE INTERÉS: Se analizaron las variables demográficas (edad, sexo), la procedencia (urgencias, planta de hospitalización, quirófano), el tipo de paciente (médico, quirúrgico), las comorbilidades y el SAPS 3 como puntuación de gravedad al ingreso, estancia en UCI y hospitalaria, además de mortalidad en la UCI y en el hospital. RESULTADOS: Se incluyeron 504 pacientes en el grupo on-hours y 602 en el grupo off-hours. En el análisis multivariable los factores asociados de forma independiente con la mortalidad hospitalaria fueron SAPS 3 (OR 1,10; IC 95% 1,08-1,12) y grupo off-hours (OR 2,00; IC 95% 1,20-3,33). En un análisis de subgrupos del grupo off-hours el ingreso de los pacientes en fin de semana o festivo frente a las noches de los días de diario se asoció de forma independiente con la mortalidad hospitalaria (OR 2,30; IC 95% 1,23-4,30). CONCLUSIONES: Ingresar en el grupo off-hours se asocia de forma independiente con la mortalidad. El ingreso en festivo se asocia de forma independiente con la mortalidad, independientemente del turno en que se produzca el ingreso los días de diario
OBJECTIVE: To assess the repercussion of the timing of admission to the ICU upon patient prognosis. DESIGN: A prospective, observational, non-interventional cohort study was carried out. Scope: A second level hospital with 210 operational beds and a general ICU with 8 operational beds. PATIENTS OR PARTICIPANTS: The study comprised all patients admitted to the ICU during 3 years (January 2010 to December 2012), excluding those subjects admitted from the operating room after scheduled surgery. The patients were divided into 2 groups according to the timing of admission (on-hours or off-hours). INTERVENTIONS: Non-interventional study. VARIABLES OF INTEREST: An analysis was made of demographic variables (age, sex), origin (emergency room, hospital ward, operating room), comorbidities and SAPS 3 as severity score upon admission, length of stay in the ICU and hospital ward, and ICU and hospital mortality. RESULTS: A total of 504 patients were included in the on-hours group, versus 602 in the off-hours group. Multivariate analysis showed the factors independently associated to hospital mortality to be SAPS 3 (OR 1.10; 95% CI 1.08-1.12), and off-hours admission (OR 2.00; 95% CI 1.20-3.33). In a subgroup analysis of the off-hours group, the admission of patients on weekends or non-working days compared to daily night shifts was found to be independently associated to hospital mortality (OR 2.30; 95% CI 1.23-4.30). CONCLUSIONS: Admission to the ICU in off-hours is independently associated to patient mortality, which is also higher in patients admitted on weekends and non-working days compared to the daily night shifts
Subject(s)
Humans , Intensive Care Units/statistics & numerical data , Health Services Statistics , Prognosis , Risk Factors , Prospective Studies , Inpatients/statistics & numerical dataABSTRACT
OBJECTIVE: To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital ("ICU without walls" project) results in decreased mortality among patients admitted to the ICU during those days. DESIGN: A quasi-experimental before-after study was carried out. SETTING: A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds. PATIENTS OR PARTICIPANTS: The control group involved no "ICU without walls" activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the "ICU without walls" activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded. VARIABLES OF INTEREST: An analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital. RESULTS: A total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P<.001), severity upon admission (median SAPS 3 score 52 [percentiles 25-75: 42-63) in the control group versus 48 [percentiles 25-75: 40-56] in the intervention group; P=.008) and mortality in the ICU (11% in the control group [95% CI 8-14] versus 3% [95% CI 1-7] in the intervention group; P=.003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06-1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12-0.89). CONCLUSIONS: Extension of the "ICU without walls" activity to holidays and weekends results in a decrease in mortality in the ICU.
Subject(s)
Holidays , Hospital Mortality , Intensive Care Units/organization & administration , Aged , Appointments and Schedules , Controlled Before-After Studies , Decision Support Techniques , Diagnosis-Related Groups , Early Diagnosis , Female , Hospital Bed Capacity , Hospital Mortality/trends , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Organ Dysfunction Scores , Patient Admission , Patient Care Team , Prognosis , Risk Factors , Secondary Care Centers , Simplified Acute Physiology Score , Spain , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the repercussion of the timing of admission to the ICU upon patient prognosis. DESIGN: A prospective, observational, non-interventional cohort study was carried out. SCOPE: A second level hospital with 210 operational beds and a general ICU with 8 operational beds. PATIENTS OR PARTICIPANTS: The study comprised all patients admitted to the ICU during 3 years (January 2010 to December 2012), excluding those subjects admitted from the operating room after scheduled surgery. The patients were divided into 2 groups according to the timing of admission (on-hours or off-hours). INTERVENTIONS: Non-interventional study. VARIABLES OF INTEREST: An analysis was made of demographic variables (age, sex), origin (emergency room, hospital ward, operating room), comorbidities and SAPS 3 as severity score upon admission, length of stay in the ICU and hospital ward, and ICU and hospital mortality. RESULTS: A total of 504 patients were included in the on-hours group, versus 602 in the off-hours group. Multivariate analysis showed the factors independently associated to hospital mortality to be SAPS 3 (OR 1.10; 95% CI 1.08-1.12), and off-hours admission (OR 2.00; 95% CI 1.20-3.33). In a subgroup analysis of the off-hours group, the admission of patients on weekends or non-working days compared to daily night shifts was found to be independently associated to hospital mortality (OR 2.30; 95% CI 1.23-4.30). CONCLUSIONS: Admission to the ICU in off-hours is independently associated to patient mortality, which is also higher in patients admitted on weekends and non-working days compared to the daily night shifts.
Subject(s)
Hospital Mortality , Intensive Care Units , Patient Admission , Humans , Length of Stay , Personnel Staffing and Scheduling , Prognosis , Prospective Studies , Time FactorsABSTRACT
No disponible
Subject(s)
Humans , Prone Position/physiology , Respiratory Tract Diseases/complications , Respiratory Tract Diseases/physiopathology , Respiratory Tract Diseases/therapy , Respiratory Mechanics/physiology , Diaphragm/physiology , Diaphragm/physiopathology , Tidal Volume/physiology , Ventilation-Perfusion Ratio/physiology , Pulmonary Ventilation/physiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Pneumothorax , Respiratory Insufficiency , Diagnostic Errors , Anti-Bacterial Agents/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Physical Therapy Modalities , Electric Impedance , Tomography, X-Ray Computed/methods , Evaluation of Results of Therapeutic InterventionsSubject(s)
Physical Therapy Modalities , Pulmonary Atelectasis/diagnostic imaging , Tomography/methods , Electric Impedance , Humans , Male , Metapneumovirus/isolation & purification , Middle Aged , Paramyxoviridae Infections/complications , Paramyxoviridae Infections/virology , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Pulmonary Atelectasis/etiology , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapyABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Respiration, Artificial , Tomography , Electric Impedance , Monitoring, Physiologic/methodsSubject(s)
Respiration, Artificial , Tomography , Electric Impedance , Female , Humans , Middle Aged , Monitoring, Physiologic/methodsABSTRACT
INTRODUCTION: The preoperative lymphoscintigraphy to the Sentinel Node Biopsy (SNB) can reproduce the lymphatic drainage of the tumour in breast cancer. OBJECTIVES: To establish the pattern of lymphatic drainage of the mammary tumors by means of isotopic lymphoscintigraphy and determine the factors that could influence the negativity of the scintigraphy. METHODS: 121 patients with breast cancer who were going to undergo mammary surgery were studied with SNB. One day before the operation, 37 MBq 99mTc-colloidal sulphide colloid in a volume of 2 ml was injected in peritumoral tissue. Mammary lymphoscintigraphies were performed at 30 minutes and 18 hours P.I., in ANT and OA projections of the corresponding chest. After, the clinical-biological parameters and their influence on the result of the lymphoscintigraphy were analyzed. RESULTS: The scintigraphy were positive in 85 % of the patients. The axillary chain was observed in 97 % and the internal mammary chain in 11 %. The factors associated to the absence of visualization of the sentinel node were: older than 50 years (94 %), menopause (89 %), tumoral size > or = 2 cm (67 %), axillary metastases (67 %), the overexpression of C-erbB-2 oncoprotein (44 %) and proliferative activity > 10 % (67 %). CONCLUSIONS: The peritumoral injection of the radiocolloid establishes the lymphatic drainage pattern in the patients with breast cancer. Its absence of visualization can be associated to circumstances like: age > or = 50 years, menopause, tumoral size > or = 2 cm, axillary metastases, tumoral overexpression of the C-erbB-2 oncoprotein and high proliferative activity of the mammary tumor.
Subject(s)
Breast Neoplasms/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Lymphoscintigraphy , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Axilla , Female , Humans , Middle Aged , Preoperative Care , Radiopharmaceuticals , Risk Factors , Technetium Tc 99m Sulfur ColloidABSTRACT
Introducción: La linfoscintigrafía previa a la Biopsia del Ganglio Centinela (BGC) puede reproducir el drenaje linfático tumoral en el cáncer de mama. Objetivos: Establecer el patrón de drenaje linfático de los tumores mamarios mediante linfoscintigrafía isotópica y determinar los factores que pudieran influir en su negatividad.Métodos: Se estudiaron 121 pacientes con cáncer de mama, que iban a ser sometidas a cirugía mamaria con BGC. El día anterior se inyectó peritumoralmente, 37 MBq de 99mTc-sulfuro coloidal en un volumen de 2 ml. Se obtuvieron linfogammagrafías mamarias a los 30 minutos y 18 horas P.I., en proyecciones ANT y OA del hemitorax correspondiente. Posteriormente se analizaron los parámetros clínico-biológicos y su influencia en el resultado de la linfogammagrafía. Resultados: Las gammagrafías fueron positivas en el 85 por ciento de las pacientes. La cadena axilar se observó en el 97 por ciento y la MI en el 11 por ciento. Los factores asociados a la ausencia de visualización del GC fueron: edad superior a 50 años (94 por ciento), menopausia (89 por ciento), tamaño tumoral 2 cm (67 por ciento), las metástasis ganglionares axilares (67 por ciento), la sobreexpresión de la oncoproteína C-erbB-2 (44 por ciento) y una actividad proliferativa > 10 por ciento (67 por ciento).Conclusiones: La inyección peritumoral del radiocoloide establece el patrón de drenaje linfático tumoral en las pacientes con cáncer de mama. La ausencia de visualización del mismo puede asociarse a circunstancias como: edad 50 años, postmenopausia, tamaño tumoral 2 cm, metástasis axilares, sobreexpresión tumoral de la oncoproteina C-erbB-2 y alta actividad proliferativa del tumor mamario (AU)
Subject(s)
Middle Aged , Adult , Aged, 80 and over , Aged , Female , Humans , Risk Factors , Technetium Tc 99m Sulfur Colloid , Radiopharmaceuticals , Preoperative Care , Sentinel Lymph Node Biopsy , Axilla , Lymphatic Metastasis , Lymphatic System , Breast NeoplasmsSubject(s)
Breast Neoplasms/chemistry , Carcinoma, Ductal, Breast/chemistry , Neoplasm Proteins/analysis , Receptors, Estrogen/analysis , Aneuploidy , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , ErbB Receptors/analysis , Estrogens , Female , Glycoproteins/analysis , Humans , Hyaluronan Receptors/analysis , Neoplasms, Hormone-Dependent/chemistry , Neoplasms, Hormone-Dependent/pathology , Peptides/analysis , Progesterone , Prognosis , Receptors, Progesterone/analysis , Tissue Plasminogen Activator/analysisABSTRACT
Introducción. El antígeno prostático específico (PSA) es una serinproteasa que puede ser detectada en las secreciones mamarias. Su comportamiento parece ser opuesto al de otros marcadores tumorales y puede ayudar a establecer el diagnóstico de carcinomas mamarios. Hemos realizado el presente trabajo con objeto de estudiar su comportamiento en secreciones mamarias no malignas. Pacientes y métodos. Hemos determinado, mediante un fluoroinmunoanálisis (EG&G Wallac, Finlandia) las concentraciones de PSA en 79 secreciones mamarias, correspondiendo a 67 ectasias ductales, 5 mastitis y 7 papilomas intraductales. Resultados. En las ectasias ductales los valores de PSA estuvieron comprendidos entre 0,1 y 89,9 ng/ml (mediana 6,0) y fueron mayores (p = 0,085) en la fase luteínica (intervalo: 0,189,9; mediana 9,2) que en la folicular (intervalo: 0,1-81 ng/ml; mediana 5,8). En las mastitis las cifras de PSA estuvieron comprendidas entre 0,1 y 375 ng/ml (mediana 33), mientras que en los papilomas intraductales oscilaron entre 0,1 y 23 ng/ml (mediana 0,1). Observamos sólo diferencias significativas (p = 0,010) entre las concentraciones del PSA de las ectasias y papilomas. Cifras de PSA superiores a 1 ng/ml se constataron en 48 de las 67 ectasias, 4 de las 5 mastitis y 2 de los 7 papilomas. Conclusiones. Los resultados anteriores nos sugieren que es posible detectar altas concentraciones de PSA en las secreciones mamarias por procesos no malignos mamarios, principalmente ectasias y mastitis, mientras que en los papilomas intraductales las concentraciones antigénicas fueron mucho menores. Asimismo, nuestros resultados apoyan la posible utilidad del PSA en las secreciones mamarias como indicador de riesgo de cáncer de mama tal como han sugerido ciertos grupos (AU)
Subject(s)
Female , Humans , Breast , Biomarkers, Tumor , Bodily Secretions , Prostate-Specific Antigen , Breast NeoplasmsABSTRACT
A patient who initially presented with clinical and laboratory signs of bacterial meningitis developed four more similar episodes within a 6-month period. Immune system studies were unremarkable. A tentative diagnosis of Mollaret's meningitis was established after the third episode. Cranial computed tomography performed during the acute phase of the initial episode was normal, but, after the fourth scan, when the patient was asymptomatic, magnetic resonance imaging revealed a cyst in the anterior aspect of the medulla. Partial excision allowed for pathologic analysis, which established the diagnosis of epidermoid cyst. The differential diagnosis of recurrent aseptic meningitis should include Mollaret's meningitis and dermoid-epidermoid cysts. Neuroimaging studies, preferably magnetic resonance imaging, should be performed at a time when patients are asymptomatic.
