[Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review].

Dyadic self-care in chronic heart failure (CHF) is key to ensure treatment continuity, reduce complications and readmissions, and minimise caregiver burden, but it requires specific strategies. The aim of the study was to identify dyadic self-management interventions in CHF in hospital settings by means of a systematic literature review conducted in the Pubmed, CINAHL and PsycInfo databases. Methodological quality was assessed according to CASPe and Joanna Briggs Institute tools. The main components of the interventions were identified: delivery format; dimensions and strategies used (cognitive-attitudinal, affective-emotional and behavioural); providers and recipients; measurement instruments used; and effectiveness. Most of the studies demonstrated improved outcomes, especially in depression and/or anxiety symptoms, adherence to treatment, diet and weight control. Innovative interventions that include components of the three dimensions identified and the use of valid, reliable and specific scales to measure outcomes are recommended.

Intervenciones de autocuidado diádico en la insuficiencia cardíacacrónica en el contexto hospitalario: una revisión sistemática / Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review

El autocuidado diádico en la insuficiencia cardiaca cró-nica (ICC) es clave para garantizar la continuidad del tra-tamiento, disminuir las complicaciones y los reingresos, yminimizar la sobrecarga del cuidador, pero demanda estra-tegias específicas. El objetivo fue identificar las intervencio-nes de autocuidado diádico en la ICC en el contexto hospi-talario mediante una revisión sistemática de la literatura enPubMed, CINAHL y PsycInfo; la calidad metodológica se valo-ró según las herramientas de CASPe y del Joanna Briggs Ins-titute. Se identificaron los principales componentes de lasintervenciones: formato de administración; dimensiones yestrategias utilizadas (cognitivo-actitudinal, afectiva-emo-cional y conductual); proveedores y receptores; instrumen-tos de medida utilizados; y efectividad. La mayoría de estu-dios mejoraron los resultados, especialmente síntomas dedepresión y/o ansiedad, adherencia al tratamiento, dieta ycontrol del peso. Se recomiendan intervenciones innova-doras que incluyan componentes de las tres dimensionesidentificadas y el uso de escalas válidas, fiables y específicaspara medir los resultados.(AU)

Dyadic self-care in chronic heart failure (CHF) is key toensure treatment continuity, reduce complications and re-admissions, and minimise caregiver burden, but it requiresspecific strategies. The aim of the study was to identify dy-adic self-management interventions in CHF in hospital set-tings by means of a systematic literature review conductedin the Pubmed, CINAHL and PsycInfo databases. Methodo-logical quality was assessed according to CASPe and JoannaBriggs Institute tools. The main components of the inter-ventions were identified: delivery format; dimensions andstrategies used (cognitive-attitudinal, affective-emotionaland behavioural); providers and recipients; measurementinstruments used; and effectiveness. Most of the studiesdemonstrated improved outcomes, especially in depressionand/or anxiety symptoms, adherence to treatment, diet andweight control. Innovative interventions that include com-ponents of the three dimensions identified and the use ofvalid, reliable and specific scales to measure outcomes arerecommended(AU)

Factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism.

OBJECTIVE: The objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). METHODS: A retrospective observational study was designed in 195 patients (mean age: 59.2 ±â€¯13.0 years; 77% woman) with PHPT (calcium: 11,3 ±â€¯1,1 mg/dl and PTH: 218 ±â€¯295 pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. RESULT: 50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146 ±â€¯98 vs. 244 ±â€¯334; p < 0,001), adenomas with smaller sonographic dimensions (maximum diameter: 1,2 ±â€¯0,4 vs. 1,7 ±â€¯0,9 cm; p = 0,001 and volume: 0,36 ±â€¯0,43 vs. 1,7 ±â€¯4,1 cm3; p < 0,001), localized more frequently in upper parathyroid glands (37% vs 14%; p = 0,005) and associated more frequently to thyroid nodules (72% vs 57%; p = 0,045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1,3 ±â€¯0,5 vs. 1,9 ±â€¯1,1 cm; p = 0,008 and volume: 0,30 ±â€¯0,20 vs. 1,2 ±â€¯1,1 cm3; p < 0,001), less heavy (567 ±â€¯282 vs. 1470 ±â€¯1374 mgr.; p = 0,030) and were localized more frequently in upper situation (65% vs 16%; p < 0,001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1 cm (OR: 5,77; IC 95: 1,46-22,71) and upper adenoma localization were observed (OR: 8,05; IC 95%: 2,22-29,16). CONCLUSIONS: One in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1 cm and upper adenoma localization.

Characterization of toasted cereal flours from the Canary Islands (gofios).

In this work, different types of gofio produced in the Canary Islands were characterized on the basis of physico-chemical parameters as well as spectral features. An overall of 7 physico-chemical parameters (moisture, ash, pH, Cu, Fe, Mn and Zn) were determined in 64 samples from different cereals and legumes, and IR spectra of all samples were registered. The chemometric processing of both, metal ions contents determined by atomic absorption spectrophotometry, and the MIR spectra, with various techniques including cluster analysis, principal component analysis, and discriminant analysis enabled the accurate characterization and classification of the gofio samples according to the grain used in their obtaining process.

Poor zinc status is associated with increased risk of insulin resistance in Spanish children.

Zn plays a key role in the synthesis and action of insulin. The aim of the present work was to determine whether a poorer Zn status was associated with insulin resistance in a group of 357 Spanish schoolchildren. Zn intake was determined by using a 3 d food record (i.e. Sunday to Tuesday). The body weight, height and waist and hip circumferences of all subjects were recorded and fasting plasma glucose, insulin and Zn concentrations were determined. Insulin resistance was determined using the homoeostasis model assessment (HOMA) marker. Children (11·5 %) with Zn deficiency (serum Zn concentration < 10·7 µmol/l) had higher HOMA values than those with a more satisfactory Zn status (1·73 (sd 0·93)) compared with 1·38 (sd 0·90; P < 0·05). An inverse correlation was found between the HOMA value and the serum Zn concentration (r - 0·149, P < 0·05). The risk of having a greater insulin resistance value (HOMA greater than the 75th percentile) increased with age (OR 1·438; 95 % CI 1·021, 2·027) and BMI (OR 1·448; 95 % CI 1·294, 1·619) and decreased as Zn serum levels increased (OR 0·908; 95 % CI 0·835, 0·987; P < 0·001). Moreover, an inverse relationship was observed between HOMA values and Zn dietary density (r - 0·122), and the Zn intakes of male children with a HOMA value of >3·16 made a significantly smaller contribution to the coverage of those recommended (59·7 (sd 14·7) %) than observed in children with lower HOMA values (73·6 (sd 18·2) %; P < 0·05). Taking into account that Zn intake was below than that recommended in 89·4 % of the children, it would appear that increasing the intake of Zn could improve the health and nutritional status of these children, and thus contribute to diminish problems of insulin resistance.

Fat intake and asthma in Spanish schoolchildren.

OBJECTIVES: To study the relationship between lipid, fatty acid and lipid-rich food intake and current asthma in a group of Spanish schoolchildren. SUBJECTS/METHODS: The subjects of this cross-sectional study were 638 Spanish schoolchildren (8-13 years of age). The weight and height of all the subjects were recorded. A questionnaire, completed by the subjects' parents, was used to obtain personal and health information. Current asthma was established when the children had ever had asthma, if they had been diagnosed with asthma by a doctor and if they had been treated with medications at some time in the previous 12 months. Food intake was monitored using a 3-day food record. All foods consumed were converted into energy and nutrients. RESULTS: The energy derived from lipids, saturated fatty acids (SFAs) and myristic and palmitic acids was independently associated with current asthma (Odds Ratio (OR) third tertile 2.85 (1.01-8.07) P=0.049, 10.00 (0.89-111.97) P=0.002, 11.21 (1.36-92.24) P=0.002, 7.58 (1.40-41.03) P=0.022, respectively), as was the intake of butter (OR third tertile 2.97 (1.01-8.68) P=0.001). No relationship was seen between this condition and the intake of any other fatty acid, the n-6/n-3 ratio, nor the consumption of margarine, milk products, fish, meat, eggs or vegetable oils. CONCLUSIONS: Increased intakes of SFAs, myristic and palmitic acids and butter seem to be related to the risk of current asthma in children.

Valoración manual de la fuerza muscular frente a dinamometría instrumental / No disponible

No disponible

Estudio del consumo de fármacos inadecuados o no indicados en el anciano que ingresa en un Servicio de Medicina Interna / Study of the consumption of innapropiate medicaments in elder hospitalized in the internal medicine service

Introducción: Los pacientes ancianos se caracterizan por el alto grado de polimedicación. Este factor se ha mostrado el más importante en la aparición de efectos adversos (EAF). El estudio de los fármacos ayuda a establecer cuales son inapropiados y por lo tanto se deben retirar, disminuyendo de esta forma la posibilidad de EAF. Material y Métodos: Estudio prospectivo y observacional. Criterio de inclusión: pacientes de > 64 años que ingresan en Medicina Interna. Se definió como fármaco inapropiado los medicamentos de baja utilidad terapéutica (UTB), los no indicados, y los inadecuados para el anciano. Mediante el programa informático SPSS 11.5 se analizaron las posibles variables relacionadas con el consumo. Resultados: Se incluyeron en el estudio 172 ancianos. La media de medicamentos por persona y día fue de 5,34 (0-15). El 52,5% consumían un fármaco inapropiado (36,6% inadecuado para el anciano, 15% noindicado y 12% UTBs). El análisis multivariante asocia el consumo de estos fármacos a un mayor número de patologías (p < 0,012), a un mayor consumo de medicamentos (p < 0,001) y a la procedencia de residencias de ancianos (p < 0,001). Sólo el consumo de fármacos no adecuados para el anciano se asocia a aumento de EAF. Conclusión: La mitad de los ancianos toma al menos un fármaco deforma innecesaria, y la mayoría de estos fármacos favorece la aparición de EAF

Background: The elderly patients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD’s possibility. Patients and Method: Prospective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed. Results: 172 elders were included in the study. The average of medicines for person and day belonged to 5.34 (0-15). 52.5% was consuming an inappropriate medicament (36.6% inadequate for the elder, 15% not indicated, and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p <0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.001). Only the consumption of medicaments not adapted for the elder is associated with increase of EAD. Conclusion: The half of the elders takes at least a medicament of unnecessary form, and the majority of these medicaments favors appearance of EAD

[Study of the conpsumption of innapropiate medicaments in elder hospitalized in the Internal Medicine Service]. / Estudio del consumo de fármacos inadecuados o no indicados en el anciano que ingresa en un Servicio de Medicina Interna.

BACKGROUND: The elderly patients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD's possibility. PATIENTS AND METHOD: Prospective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed. RESULTS: 172 elders were included in the study. The average of medicines for person and day belonged to 5.34 (0-15). 52.5% was consuming an inappropriate medicament (36.6% inadequate for the elder, 15% not indicated, and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p < 0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.001). Only the consumption of medicaments not adapted for the elder is associated with increase of EAD. CONCLUSION: The half of the elders takes at least a medicament of unnecessary form, and the majority of these medicaments favors appearance of EAD.

Fatiga en pacientes con secuelas de poliomielitis. Influencia en la calidad de vida relacionada con la salud y en las actividades de la vida diaria / Fatigue in patients with poliomyelitis sequels. Influence in quality of life related with health and daily life activities

Objetivo. Examinar la prevalencia de fatiga en una muestra de supervivientes de la poliomielitis y describir la repercusión de ésta en las actividades de la vida diaria (AVD) y en la calidad de vida relacionada con la salud. Material y métodos. Se presenta un estudio transversal, con una muestra de 37 sujetos que padecieron poliomielitis. Los instrumentos de medida utilizados fueron: Escala de Severidad de la Fatiga (ESF), escala analógica visual (EAV) para la estimación de la fatiga y del dolor, Nottingham Health Profile, índice de Barthel y escala de Lawton y Brody. Se ha aplicado para el contraste de medias entre grupos la U de Mann Whitney y para valorar la asociación entre dos variables cuantitativas, la correlación de Spearman. El nivel de significación estadística aceptado fue del 5 % (p < 0,05). Resultados. La puntuación media en la ESF fue 5,0 (desviación estándar [DE] 1,3) y en la EAV de fatiga física 45,5 mm (DE 33,3). No se encontró relación entre la presencia de problemas respiratorios en la fase aguda, la edad del ataque agudo o el grado de afectación y una mayor fatiga. La presencia de fatiga influenció en la calidad de vida relacionada con la salud, en las dimensiones energía, relaciones sociales y movilidad. No se encontraron diferencias significativas entre la presencia de fatiga y una mayor dificultad para realizar las AVD. Discusión. Aunque la fatiga no parece influenciar en las AVD, sí afecta a la calidad de vida relacionada con la salud en los pacientes con secuelas de poliomielitis

Objective. To examine the prevalence of fatigue perceived among a sample of polio survivors, and to analyze association between level of fatigue and difficulty to carry out functional activities and how this affects health-related quality of life. Material and methods. A cross-sectional trial with 37 former polio subjects. Measurement instruments used were Fatigue Severity Scale (FSS), visual analogy scale for estimation of fatigue and pain, Nottingham Health Profile, Barthel Index and Lawton and Brody Scale assessments. The Mann-Whitney U-test was used for comparison between independent groups and the Spearman rank correlation test to evaluate the association between quantitative variables. Results. Mean score in FSS was 5.0 (SD 1.3) and in VAS of physical fatigue was 45.5 mm (SD 33.3). No relationship was found between the presence of respiratory problems, age at polio onset and polio involvement and higher perceived fatigue in the sample studied. Presence of fatigue influenced health-related quality of life, mainly in energy, social isolation and physical mobility. No significant difference was found between presence of fatigue and higher perceived difficulty in performing ADL. Discussion. Although fatigue does not seem to influence activities in daily living, it affects health-related quality of life in polio survivors subjects

Revisión del tratamiento en pacientes con Esclerosis Múltiple / Review of treatment on Multiple Sclerosis patients

La esclerosis múltiple (EM) es una enfermedad inflamatoria y desmielinizante que afecta, de forma adquirida, a la mielina del sistema nervioso central (SNC). Lo más característico de la clínica de la EM es su gran variabilidad, apareciendo signos y síntomas dependiendo de la localización de las lesiones que puede ocurrir a lo largo de todo el neuroeje. En la actualidad no existe un tratamiento curativo de la EM, por lo que la fisioterapia adquiere un valor importante a la hora de mantener y/o mejorar el estado funcional de cada paciente. El fisioterapeuta debe adaptarse al paciente en cada momento de su evolución, atendiendo las alteraciones que vayan apareciendo a medida que la enfermedad va avanzando. Como síntomas más frecuentes, la espasticidad, la debilidad, la ataxia, la fatiga y las alteraciones de la marcha, aparecerán en un gran número de sujetos con EM, de manera aislada o en conjunto, siendo el papel del fisioterapeuta minimizar estas alteraciones mediante técnicas cinesiterápicas y de fisioterapia especializadas en trastornos neurológicos, con el fin de mantener una calidad de vida aceptable para el paciente. Se ha realizado una revisión bibliográfica en las siguientes bases de datos médicas: Medline, Embasse, IME, Cinhal, Cochrane, de todos los artículos publicados entre 1987-2005 con las siguientes palabras clave: esclerosis múltiple, fisioterapia, rehabilitación y espasticidad, así como en libros de referencia relacionados con el tema

Multiple Sclerosis (MS) is an inflamatory and demyelinative disease which affects central nervous system myelin. The most characteristic clinic in MS is its variability, with signs and symptoms depending on the localitation of the injuries which can appear in all neuroaxis. Today there isn't a healing therapy in MS. Thats why physiotherapy acquires an important value to maintain and/or improve the patient functional status. Physiotherapist must adapt the treatment to the patient all the time, attending the disturbances which can appear when the disease progress. The most common symptoms, spasticity, weakness, ataxia, fatigue and gait disturbances, will appear in a great number of patients with MS. The physiotherapist role is to reduce these injuries through kynesitherapy and neurological physiotherapy techniques, in order to maintain an acceptable patient's life quality. It has been done a review in these data bases: Medline, Embasse, IME, Cinhal, Cochrane of all publicated articles between 1987-2005 with these keywords: multiple sclerosis, physiotherapy, rehabilitation, spasticity, and in books which are related with the theme

Influencia de las secuelas de la poliomielitis y síntomas del síndrome postpolio en las actividades de la vida diaria y en la calidad de vida relacionada con la salud / Influence of poliomyelitis sequelae and postpolio syndrome symptoms in activities of daily living and in health-related quality of life

Objetivos. Describir la repercusión de las secuelas de la poliomielitis en las actividades de la vida diaria (AVD) y en la calidad de vida relacionada con la salud. Material y métodos. Se presenta un estudio transversal en 37 personas que padecieron la poliomielitis y que presentan nuevos síntomas. Los instrumentos de medida utilizados fueron: el índice de Barthel, la escala de actividades instrumentales de la vida diaria de Lawton y Brody, y el Nottingham Health Profile (NHP). Se valoró el dolor en la última semana mediante una escala analógica visual (EAV). Se ha aplicado para el contraste de medias entre grupos la U de Mann Whitney y para valorar la asociación entre dos variables cuantitativas, la correlación de Spearman. El nivel de significación estadística aceptado ha sido del 5 % (p < 0,05). Resultados. La edad media era de 49 años, correspondiendo el 62 % a mujeres y el 38 % a varones. Los resultados de la primera parte del NHP (NHP-I) muestran que las dimensiones más afectadas en la población de estudio son la movilidad, el dolor y la energía, siendo la menos afectada la dimensión social. En la segunda parte del NHP (NHP-II), las actividades más afectadas fueron los trabajos domésticos y el trabajo. No se encontró relación estadísticamente significativa entre una mayor dependencia en las AVD y una mayor puntuación total del NHP. Conclusión. Las secuelas y los nuevos síntomas presentes en individuos que padecieron la poliomielitis dificultan la realización de las AVD, afectando a su calidad de vida

Purpose. To describe the repercussion of poliomyelitis sequels in activities of daily living (ADL) and health-related quality. Method. A cross-sectional study with thirty-seven former polio patients with new symptoms is presented. The measurement instruments used were the Barthel Index, Lawton and Brody Scale and the Nottingham Health Profile (NHP) assessments. Pain in last week was assessed with a visual analogue scale (VAS). The Mann-Whitney U-test was used for comparison between independents groups. The Spearman rank correlation test was used to evaluate the association between quantitative variables. Statistical significance level accepted was 5 % (p < 0.05). Results. Mean age was 49 years; 62 % were female and 38 % were males. The NHP part I demonstrated that the most affected dimensions in our sample are physical mobility, pain and energy and the less affected is social isolation. In NHP part II, the most affected activities were housework and work. No significant differences were found between a greater dependence in ADL and a greater total score in NHP. Conclusions. Sequels and new signs and symptoms detected in former polio subjects difficult the capacity to realize ADL, affecting to health-related quality of life

Fuerza de las extremidades inferiores, parámetros y ayudas para la marcha en pacientes con secuelas de la poliomielitis / Strength of lower limbs, parameters and help for walking in patients with poliomyelitis sequels

Objetivo. Se propone describir los peak torques (PT) de diferentes grupos musculares de las extremidades inferiores y analizar su relación con parámetros de la marcha, necesidad de ayudas para la deambulación y el Índice de Discapacidad para la Deambulación (IDA) en pacientes que sufrieron poliomielitis. Pacientes y métodos. Se presenta un estudio transversal en personas que padecieron poliomielitis que procedían de dos asociaciones madrileñas. Se contactó con 49 personas, de las cuales 40 aceptaron participar en el estudio. Se descartaron 3 pacientes por cumplir alguno de los criterios de exclusión. A cada participante se le administró un cuestionario cerrado que contenía preguntas sobre datos sociodemográficos, necesidad de ayudas para la deambulación y uso de ortesis. Se realizaron valoraciones isométricas e isocinéticas con un dinamómetro Biodex, la prueba de 10 m de marcha y se aplicó el IDA. Análisis estadístico. Se ha utilizado el coeficiente de correlación de Pearson y el de Spearman en variables paramétricas y no paramétricas, respectivamente. El nivel de significación estadística aceptado ha sido del 5 % (p < 0,05) con un intervalo de confianza del 95 %. Resultados. Nuestra muestra, presenta una velocidad de marcha inferior a la población sana. Se han encontrado relaciones significativas entre los PT isocinéticos en flexoextensión de rodilla y la velocidad de marcha. Los valores de la cadencia en nuestra serie se presentan próximos a lo normativo, por lo que nos sugiere la aparición de compensaciones. La fuerza de los flexores plantares del tobillo de la extremidad menos afectada es el factor determinante para la velocidad de la marcha

Objective. We proposed to describe the peak torques (PT) of different muscular groups in the lower limbs and their relationship with gait parameters, the need for help in deambulation and the ambulation disability index in patients with poliomyelitis (PM). Patients and Methods. We present a cross-sectional study of patients from two Madrid associations who suffered PM. Forty out of 49 persons contacts agreed to participate in the study. Three patients were excluded because they fulfilled some of the exclusion criteria. Each volunteer was given a closed questionnaire containing questions on sociodemographic data, need for help in deambulation and the use of orthosis. Isometric and isokinetic evaluations were made using a Biodex Dynamomether, the 10 meters gait test, and Ambulation Disability Index was administered. Statistics analyses. Pearson's and Spearman's correlation coefficient have been used in parametric and non-parametric values, respectively. Statistical significant level accepted was 5 % (p < 0.05). Results. Our sample has a deambulation rate lower than the healthy population. Significant relationships have been found between the isokinetic PT in flex-extension of the knee and deambulation rate. The rhythm values in our series was close to the normative, which suggests the appearance of compensations. Ankle plantar flexor force of the less affected limb is the determining factor for the deambulation rate

Nuevos síntomas en pacientes con secuelas de poliomielitis. Síndrome pospolio / New symptoms in polio survivors. Syndrome postpolio

Objetivo. Describir la situación clínica y los síntomas del síndrome pospolio de una muestra de personas que padecieron poliomielitis. Pacientes y métodos. Se presenta un estudio transversal en37 personas residentes en Madrid que padecieron poliomielitis. Se analizaron variables sociodemográficas como sexo, edad, nivel de estudios, estado civil y laboral. Variables que recogen la gravedad de la poliomielitis aguda: edad, necesidad de ventilación mecánica, número de extremidades afectadas y tiempo transcurrido hasta la recuperación de la marcha. Síntomas actuales: fatiga, dolor, nueva pérdida de fuerza, atrofia muscular, calambres, fasciculaciones y su localización, trastornos respiratorios, disfagia, aumento reciente de peso e intolerancia al frío. Resultados. La edad media de la muestra era de 49 años, el 43,2 % ha cursado estudios universitarios y el 48 % tiene una situación laboral estable, aunque el 28,7 % ha tenido que abandonar su puesto de trabajo habitual por la aparición delos nuevos síntomas. La muestra seleccionada había sufrido la primo-infección a la edad de 2,2 años y el 86,5 % no habían precisado ventilación mecánica, afectándose fundamentalmente las extremidades inferiores. El 75,6 % referían dolor y el 67,6 %, fatiga, siendo éste el síntoma que les provoca subjetivamente mayor discapacidad. Refería pérdida de fuerza el91,9 % de los pacientes, sobre todo en los miembros superiores y atrofia muscular el 35,1 %, fundamentalmente en las extremidades inferiores. Discusión. En nuestra muestra la primo-infección ocurrió en una edad menor que en otros países de Europa, pudiendo condicionar una menor gravedad en la poliomielitis aguda yen el síndrome pospolio. La frecuencia de los síntomas del síndrome pospolio en nuestra muestra es similar a la descrita en otros estudios. El médico rehabilitador debe ser el responsable del tratamiento y, en ocasiones, del diagnóstico de estos pacientes

Objective. To examine the clinical status and symptoms of postpolio syndrome in polio survivors. Patients and methods. Cross-sectional study desinged in Madrid area in 37 patients with previous paralytic polio. Socio demographic variables used were: gender, age, marital status, ocuppational and educational status. Polio acute variables used were: age, ventilator weaning, number of affected extremities and recovery time of gait. Clinical features: fatigue, pain, new weakness, atrophy, cramps, fasciculations, breathing difficulties, disphagia, increase of weight and cold intolerance. Results. The average age is 49 years, 43.2 % followed university studies and 48 % were employed, although 28.7 %had quit the job. The onset of acute poliomielitis was at an average of2 years and 86.5 % were not ventilator weaning user, with mainly muscular paresis in lower extremities. 75.6 % presented pain and 67.6% fatigue as the worse disabling. New weakness appeared in 91.9 % and atrophy muscle in 35.1 %.Discussion. The onset of polio in Spain occurs at an earlier stage than other European countries. This way produces a less serious acute polio syntoms and postpolio syndrome. New features occur on a similar basis than other countries. The physiatrist should be the coordinator of the health-care team

Insuficiencia cardíaca de alto gasto y edema agudo de pulmón como forma de expresión inicial de tirotoxicosis secundaria a bocio multinodular tóxico / High output heart failure and pulmonary acute edema as presentation of thyrotoxicosis secondary to toxic multinodular goiter

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Escalas de valoración y tratamiento fisioterápico en la enfermedad de Parkinson / Assesment scales and physical therapy in Parkinson'Disease

La enfermedad de Parkinson es una afección atribuida al proceso degenerativo idiopático de las vías dopaminérgicas, caracterizada por temblor, rigidez muscular, acinesia, alteraciones de la postura, alteraciones del equilibrio, marcha festinante, facie inexpresiva y sialorrea entre otros. Existen multitud de escalas para valorar al enfermo de Parkinson: UPDRS (escala multidimensional, fiable y válida con pocos inconvenientes); Hoehn y Yahr (permite comparar poblaciones de pacientes con PD, pero es relativamente insensible a cambios clínicos en un mismo paciente); Ziegler-Bleton (clasificación simple, que traduce de manera global la progresión de la discapacidad motora); Escala de NUDS (evalúa la discapacidad producida por la enfermedad en las actividades de la vida diaria); Escala de Webster (basada en la Escala de Webster Original); Escala de CURS (una de las más utilizadas); Escala de la Marcha para la Enfermedad de Parkinson (permite medir los aspectos más relevantes de las alteraciones motrices del paciente); Escala de King College Hospital; Escala de ISAPD. Hoy en día los medicamentos (Levodopa, Carbidopa, Benserazida, Agonistas Dopaminérgicos, IMAO-B, ICOMT, Amantidina, medicamentos anticolinérgicos) permiten al enfermo de Parkinson aliviar eficazmente la mayor parte de sus síntomas, lo cual, combinado con la utilización de diferentes técnicas fisioterápicas dirigidas a disminuir la rigidez y el dolor, mantener una postura correcta, mejorar el equilibrio, la coordinación y la marcha, trabajar la motilidad orofacial y las transferencias, y mejorar la función cardiorrespiratoria e intestinal, permiten al paciente parkinsoniano mantener una calidad de vida aceptable (AU)

[Posture and gait disorders and the incidence of falling in patients with Parkinson]. / Trastornos de la postura y de la marcha e incidencia de caídas en pacientes con enfermedad de Parkinson.

INTRODUCTION: Although falls are one of the main causes of morbidity and mortality in patients with Parkinson's disease, studies about its incidence and predicting factors are scarce. PATIENTS AND METHODS: Our study involved 25 patients with PD (15 males and 10 females; age: 75.8 +/- 6.5 years). A closed survey was used to determine a retrospective record of falls during the last year. An analysis was performed to examine whether there was a relationship with Hoehn and Yahr staging, the score on the Up and Go scale or the Barthel index and with possible risk factors for falls. RESULTS: All the patients had suffered falls at some time over the last year (mean number of falls: 6.5 +/- 3.8). 56% of the falls happened during the phases of the day when patient mobility was at its highest. A significant correlation was found between the number of falls and the Hoehn and Yahr and the Up and Go scores. The number of falls was significantly higher in patients with loss of postural reflexes, the need for help in order to walk, and blockage and festination phenomena. No association was found with fear of falling, visual alterations or postural lateralisation. Association with the Barthel index and dependence for activities of daily living reached almost significant levels. CONCLUSIONS: Postural instability and disorders affecting gait appear to be the factors that give patients with PD a greater propensity to fall. Patients who present such alterations should be submitted to rehabilitation therapy aimed at preventing them from falling.

Application of PLS regression to fluorimetric data for the determination of furosemide and triamterene in pharmaceutical preparations and triamterene in urine.

Multivariate calibration methods that use fluorescence data for the simultaneous determination of furosemide and triamterene were developed. One of the most salient advantages of them is that the vast amount of information provided by the whole spectrum of the sample is not required. This makes analyses simple and fast. The methods require selecting chemometric parameters such as the specific spectral region and number of factors to be used. Both spectral region and number of factors are selected, simultaneously, by minimising the prediction residual error sum of squares (PRESS). The proposed methods were used for the simultaneous determination of the two drugs in real samples (pharmaceutical preparations) with no excipient separation pre-treatment, with furosemide and triamterene contents of 1.68E-3 to 4.31E-2 and 1.03E-3 to 3.12E-2mugml(-1), respectively; as well as that of triamterene at concentrations of 5.00E-4 to 5.80E-3mugml(-1) in urine samples. The ability to construct the calibration validation sets directly from the urine samples itself avoids the need to consider matrix interferences or to pre-treat the sample and/or separate some analytes The results were quite good in all cases.