Consenso sobre criterios y conjunto mínimo de datos para la derivación de pacientes candidatos a teleconsulta de nutrición enteral domiciliaria: proyecto TElENUT / Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project

Introducción: la teleconsulta es una herramienta asistencial útil en el manejo multidisciplinar de pacientes con indicación de nutrición enteral domiciliaria (NED). El empleo de diferentes herramientas de teleconsulta de NED, como ocurre en el Sistema Andaluz de Salud (SAS), conlleva heterogeneidad en los procesos de derivación entre los servicios de Atención Primaria (AP) y hospitalaria en una misma región. Objetivos: consensuar perfiles de pacientes y conjunto de datos mínimos necesarios para garantizar una derivación adecuada a la teleconsulta de NED, independientemente de la herramienta existente. Estos aspectos consensuados en Andalucía pueden servir de referencia en otras regiones. Métodos: se siguieron tres pasos consecutivos: a) revisión no sistemática de la literatura indexada sobre la teleconsulta en nutrición clínica en España; b) encuesta para conocer la implementación y las necesidades no satisfechas de las herramientas de teleconsulta en los hospitales públicos andaluces; y c) reuniones de trabajo y consenso de 14 profesionales sanitarios de AP (n = 4) y endocrinología y nutrición clínica hospitalaria (n = 10). Resultados: se consensuaron tres formularios de derivación en los que se definieron tres perfiles de pacientes, con el correspondiente conjunto mínimo de datos necesario para solicitar la teleconsulta de NED. El equipo de AP debe proporcionar este conjunto mínimo de datos al especialista en nutrición clínica a través de una herramienta de teleconsulta, implementada en el SAS. Conclusiones: tres formularios consensuados entre profesionales sanitarios involucrados en el proceso de derivación sirven para estandarizar la solicitud de teleconsulta de NED entre equipos asistenciales en función de perfiles de pacientes.(AU)

Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.(AU)

[Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project]. / Consenso sobre criterios y conjunto mínimo de datos para la derivación de pacientes candidatos a teleconsulta de nutrición enteral domiciliaria: proyecto TELENUT.

Introduction: Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.

Introducción: Introducción: la teleconsulta es una herramienta asistencial útil en el manejo multidisciplinar de pacientes con indicación de nutrición enteral domiciliaria (NED). El empleo de diferentes herramientas de teleconsulta de NED, como ocurre en el Sistema Andaluz de Salud (SAS), conlleva heterogeneidad en los procesos de derivación entre los servicios de Atención Primaria (AP) y hospitalaria en una misma región. Objetivos: consensuar perfiles de pacientes y conjunto de datos mínimos necesarios para garantizar una derivación adecuada a la teleconsulta de NED, independientemente de la herramienta existente. Estos aspectos consensuados en Andalucía pueden servir de referencia en otras regiones. Métodos: se siguieron tres pasos consecutivos: a) revisión no sistemática de la literatura indexada sobre la teleconsulta en nutrición clínica en España; b) encuesta para conocer la implementación y las necesidades no satisfechas de las herramientas de teleconsulta en los hospitales públicos andaluces; y c) reuniones de trabajo y consenso de 14 profesionales sanitarios de AP (n = 4) y endocrinología y nutrición clínica hospitalaria (n = 10). Resultados: se consensuaron tres formularios de derivación en los que se definieron tres perfiles de pacientes, con el correspondiente conjunto mínimo de datos necesario para solicitar la teleconsulta de NED. El equipo de AP debe proporcionar este conjunto mínimo de datos al especialista en nutrición clínica a través de una herramienta de teleconsulta, implementada en el SAS. Conclusiones: tres formularios consensuados entre profesionales sanitarios involucrados en el proceso de derivación sirven para estandarizar la solicitud de teleconsulta de NED entre equipos asistenciales en función de perfiles de pacientes.

Familial Mediterranean fever in the pediatric population

Familial Mediterranean fever (FMF) is the most frequent autoinflammatory disorder characterized by short, repeated, and self-limiting crises of fever and serositis. The disease was described as autosomal recessive hereditary transmission secondary to variants of the MEFV (MEditerranean FeVer) gene, even though a variable proportion of patients only present a heterozygous variant. FMF is very common in certain ethnic groups (Turkish, Armenian, Arab, and Jewish), even though it has been described throughout the Mediterranean and elsewhere in the world. The clinical manifestations are variable, with secondary amyloidosis being the most serious complication of the disorder. Treatment and prophylaxis are mainly based on the administration of colchicine, which prevents the crises and avoids complications in most cases. This study reviews the course of seven pediatric patients diagnosed with FMF during the period 2010–2018 at a district hospital. Most of the patients were of Caucasian origin, with onset at an early age in the form of fever as the main symptom, and some patients moreover presented less frequent manifestations (pericardial effusion, sensorineural hearing loss). Two cases presented plasmatic amyloid A protein elevation that subsided with the treatment. All the patients initially received colchicine, and one of them required prescription of anakinra, which was replaced by canakinumab due to a serious adverse reaction. There were no cases of consanguinity, and all the patients were of Mediterranean origin. The subjects showed a favorable course over the years, which was attributed to the early diagnosis and treatment provided(AU)

Familial Mediterranean fever in the pediatric population.

Familial Mediterranean fever (FMF) is the most frequent autoinflammatory disorder characterized by short, repeated, and self-limiting crises of fever and serositis. The disease was described as autosomal recessive hereditary transmission secondary to variants of the MEFV (MEditerranean FeVer) gene, even though a variable proportion of patients only present a heterozygous variant. FMF is very common in certain ethnic groups (Turkish, Armenian, Arab, and Jewish), even though it has been described throughout the Mediterranean and elsewhere in the world. The clinical manifestations are variable, with secondary amyloidosis being the most serious complication of the disorder. Treatment and prophylaxis are mainly based on the administration of colchicine, which prevents the crises and avoids complications in most cases. This study reviews the course of seven pediatric patients diagnosed with FMF during the period 2010-2018 at a district hospital. Most of the patients were of Caucasian origin, with onset at an early age in the form of fever as the main symptom, and some patients moreover presented less frequent manifestations (pericardial effusion, sensorineural hearing loss). Two cases presented plasmatic amyloid A protein elevation that subsided with the treatment. All the patients initially received colchicine, and one of them required prescription of anakinra, which was replaced by canakinumab due to a serious adverse reaction. There were no cases of consanguinity, and all the patients were of Mediterranean origin. The subjects showed a favorable course over the years, which was attributed to the early diagnosis and treatment provided.

Consecuencias del maltrato crónico intrafamiliar en la infancia: Trauma del desarrollo / Consequences of chronic intra-family abuse in childhood: Developmental trauma

Los traumas tempranos y repetidos en el contexto de las relaciones de apego impactan de una manera dramática en el desarrollo de los niños/as, generando una diversidad de manifestaciones psicopatológicas complejas, que se incluyen en la última versión de la Clasificación Internacional de Enfermedades (CIE-11) como un diagnóstico nuevo denominado Trastorno por Estrés Postraumático Complejo (TEPT-C). Los objetivos del presente trabajo fueron, por un lado, ofrecer una revisión de la sintomatología pos-traumática que se desarrolla por la exposición a estos eventos traumáticos, y, por otro, recapitular la evidencia empírica existente del TEPT-C o Trastorno Traumático del Desarrollo (TTD). Los resultados de los estudios revisados confirman la presencia de síntomas extensos y heterogéneos, así como graves alteraciones en la autorregulación (afectiva, cognitiva y conductual), que se ajustan a un TEPT Complejo o TTD, por lo que los datos existentes apoyarían la validez de dichos diagnósticos

Repeated and early attachment trauma has a huge impact on children's development, producing a wide range of psychopathology, which is included as a new diagnosis called complex posttraumatic stress disorder (CPTSD) in the 11th revision to the World Health Organization's International Classification of Diseases (ICD-11). The aim of this study is to provide a review of the posttraumatic symptomatology caused by exposure to complex traumatic events and to summarize the existing empirical evidence on CPTSD and developmental trauma disorder (DTD). The results of the reviewed studies confirm the presence of extensive and heterogeneous symptoms, as well as serious affective, cognitive, and behavioral self-regulation alterations, which correspond to complex PTSD or DTD. Therefore, the current data support the validity of these diagnostic proposals

Onicomadesis: un signo de alarma inusual en el anciano / Onychomadesis: an unusual sign of alarm in the elderly

No disponible

Brotes de transmisión de dengue en asentamientos poblacionales de Santiago de Cuba / Outbreaks of dengue transmission in population settlements from Santiago de Cuba

Se realizó un estudio no explicativo, descriptivo y transversal para caracterizar los brotes de dengue en asentamientos poblacionales del municipio de Santiago de Cuba durante el 2010. El universo estuvo constituido por 2 084 personas y 1 410 viviendas y locales. La información se obtuvo de la base de confirmados y de focos de Aedes aegypti, de las historias epidemiológicas y de los informes de la Unidad Municipal de Higiene y Epidemiología. En la serie, 4 localidades se encontraban entre 7½ y 39 km de la ciudad, 5 presentaban patrones de urbanización inadecuados (80,2 por ciento), la tasa de incidencia fue de 42,2 por 1000 habitantes, con primacía en el sexo femenino y predominaron las edades de 18-49 años (69,8 por ciento). Fueron identificados riesgos ambientales y 126 focos de Aedes aegypti, con mayores índices en Begoña y Sigua; también se detectaron 156 depósitos positivos en tanques bajos y artificiales (56,4 y 26,3 por ciento, respectivamente)(AU)

A non-explanatory, descriptive and cross-sectional study to characterize the dengue outbreaks in population settlements of Santiago de Cuba municipality was carried out during the 2010. The universe was formed by 2 084 persons and 1 410 houses and locals. The information was obtained from the register of confirmed cases and of Aedes aegypti foci, of the epidemiological records and of reports from the Municipal Hygiene and Epidemiology Unit. In the series, 4 towns were between 7½ and 39 km from the city, 5 had inadequate urbanization patterns (80.2 percent), the incidence rate was 42.2 per 1000 inhabitants, with primacy in the female sex and ages from18 to 49 years (69.8 percent) prevailed. Environmental risks and 126 foci of Aedes aegypti were identified, with higher figures in Begoña and Sigua; 156 positive deposits were also detected in low and artificial deposits (56.4 and 26.3 percent, respectively)(AU)