Spanish experts consensus on emergency psychiatric care in hospital emergency departments.

BACKGROUND: The demand for urgent psychiatric care is increasing, but in Spain there are no clear recommendations for emergency departments (ED) on how to optimize care for patients with psychiatric emergencies. We aimed to provide expert consensus recommendations on the requirements for general hospitals´ emergency departments to treat patients with urgent psychiatric symptoms. METHODS: We used a modified Delphi technique. A scientific committee compiled 36 statements based on literature search and clinical experience. The statements covered the organizational model, facilities, staffing, safety, patient interventions, and staff training. A panel of 38 psychiatry specialists with expertise in psychiatric emergencies evaluated the questionnaire in two rounds. RESULTS: After two rounds of voting, 30 out of 36 proposed items (83%) were agreed upon. The panel agreed that psychiatric emergencies should be managed in a general hospital, with dedicated facilities for patient assessment, direct supervision of patients at risk, and an observation unit run by the psychiatric service. In addition to the psychiatrist, the ED should have specialist nurses and security staff available 24/7. Social workers should also be readily available. ED and consulting rooms should be designed to ensure patient and staff safety. A triage system should be established for patients with psychiatric symptoms, with medical evaluation preceding psychiatric evaluation. Guidance on supplies, equipment, and staff training is also provided. CONCLUSION: All ED in general hospitals should have adequate resources to handle any psychiatric emergency. This paper provides recommendations on the minimum requirements to achieve this goal.

Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records.

BACKGROUND: There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. AIMS: This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6). METHOD: A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. RESULTS: The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. CONCLUSIONS: The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.

Physical Demands during Official Competitions in Elite Handball: A Systematic Review.

An understanding of physical demands during official competitions is essential to achieving the highest performance in handball. The aim of this systematic review was to summarise the available scientific evidence associated with physical demands during official competitions in elite handball according to playing positions, competition level and gender. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 17 studies were selected after a systematic search and selection process of three digital databases: PubMed, Web of Science and Sport Discus. The quality of the selected studies was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology checklist; the average score was 18.47 points. The sample consisted of 1175 handball players, of whom 1042 were men (88.68%) and 133 were women (11.32%). The results show that an elite handball player covered on average 3664.4 ± 1121.6 m during a match. The average running pace was 84.8 ± 17.2 m∙min-1. The total distance covered was largely greater in national competitions (4506.7 ± 647.9 m) compared with international competitions (2190.3 ± 1950.5 m) (effect size (ES) = 1.2); however, the running pace did not present any significant difference between the international or national level (ES = 0.06). In regard to gender, the total distance covered was moderately greater in female competitions (4549.1 ± 758.6 m) compared with male competitions (3332.6 ± 1257.7 m) (ES = 0.9), and the running pace was largely greater in female competitions (110.5 ± 7.2 m∙min-1) compared with male competitions (78.4 ± 19.7 m∙min-1) (ES = 1.6). In relation to playing position, backs and wings covered a moderately greater total distance (ES = 0.7 and 0.6) and slightly more meters per minute (ES = 0.4 and 0.2) than pivots. Moreover, the technical activity profile differed between playing positions. Backs performed moderately more throws than pivots and wings (ES = 1.2 and 0.9), pivots exhibited largely more body contact than backs and wings, and wings performed moderately more fast breaks (6.7 ± 3.0) than backs (2.2 ± 2.3) (ES = 1.8). Therefore, this research study provides practical applications for handball coaches and strength and conditioning professionals with respect to designing and implementing more individualised training programmes to maximise performance and reduce injury risk.

Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica / Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography

Antecedentes y objetivosLas principales guías de práctica clínica recomiendan un adecuado manejo periprocedimiento de los fármacos antitrombóticos en caso de realización de técnicas invasivas. El principal objetivo de este estudio fue evaluar si existe mayor riesgo de eventos tromboembólicos por la supresión o la disminución de la dosis de anticoagulantes o antiagregantes en pacientes sometidos a una colangiopancreatografía retrógrada endoscópica (CPRE). Pacientes y métodos: Se realizó un estudio observacional prospectivo que incluyó 644CPRE realizadas con intención terapéutica durante el año 2019 en el Hospital Universitario Reina Sofía con un seguimiento de 30días posprocedimiento. Resultados: Seis pacientes presentaron un evento tromboembólico, no hallando diferencias entre la incorrecta retirada/reintroducción del tratamiento antitrombótico y una mayor proporción de eventos tromboembólicos o hemorrágicos tras el procedimiento (p>0,05). La incidencia de eventos trombóticos fue significativamente mayor en pacientes en tratamiento con heparina o apixabán (p=0,001), así como con antecedente de fibrilación auricular (p=0,05), valvulopatía reumática (p=0,037) y tromboembolismo pulmonar recurrente (p=0,035), siendo este además un factor de riesgo independiente. Asimismo, la incidencia de hemorragia en los 30días postesfinterotomía fue significativamente menor en aquellos con implantación de prótesis biliar (p=0,04).Conclusiones: El inadecuado manejo periprocedimiento de la terapia antitrombótica no se asocia a un aumento significativo de la incidencia de eventos tromboembólicos en los 30días posteriores a la CPRE. No obstante, se aconseja seguir las recomendaciones para una adecuada suspensión/reintroducción de fármacos antitrombóticos, realizando una vigilancia y un seguimiento estrechos tras el procedimiento en pacientes con factores que aumenten el riesgo trombótico.(AU)

Background and objectives: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. Patients and methods: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. Results: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). Conclusions: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.(AU)

Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography. / Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica.

BACKGROUND AND OBJECTIVES: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. PATIENTS AND METHODS: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. RESULTS: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). CONCLUSIONS: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.

Guía de Práctica Clínica en atresia esofágica / Clinical practice guide on esophageal atresia

La atresia esofágica es una de las anomalías congénitas más frecuentes en la práctica quirúrgica neonatal. Se estima que tiene una incidencia de 1 por cada 3500 recién nacidos vivos a nivel mundial. La preparación de guías de actuación y protocolos asistenciales es tendencia en la práctica médica actual. Esta Guía de Práctica Clínica se elaboró respondiendo a la necesidad de protocolizar la atención médico-quirúrgica de la atresia esofágica. En el Centro Territorial de Cirugía Neonatal de Holguín, donde se regionaliza la atención a neonatos de las cinco provincias orientales del país con afecciones congénitas y quirúrgicas de alta complejidad, la atresia esofágica fue la afección quirúrgica más frecuente en los últimos diez años, con una supervivencia ascendente que alcanzó 94,4 por ciento en 2019. La guía que se presenta se aprobó en el Primer Consenso Nacional de Guías de Prácticas Clínicas en Cirugía Pediátrica, en Varadero, Matanzas en 2019. Incluye las principales pautas para el diagnóstico, tratamiento y seguimiento de los pacientes afectados y se considera una herramienta eficiente para mejorar los resultados en la asistencia médica y quirúrgica neonatal(AU)

Esophageal atresia is one of the most common congenital anomalies in neonatal surgical practice. It is estimated to have an incidence of 1 per 3500 live newborns globally. The preparation of action guides and care protocols is a trend in current medical practice. This Clinical Practice Guide was prepared in response to the need to protocolize the medical-surgical care of esophageal atresia. In the Territorial Center for Neonatal Surgery of Holguín, where the care of neonates from the five eastern provinces of the country with congenital and surgical conditions of high complexity is regionalized, esophageal atresia was the most frequent surgical condition in the last ten years, with an ascending survival that reached 94.4 percent in 2019. The guideline presented was approved in the First National Consensus of Clinical Practice Guidelines in Pediatric Surgery, in Varadero, Matanzas in 2019. It includes the main guidelines for the diagnosis, treatment and follow-up of affected patients and is considered an efficient tool to improve outcomes in neonatal medical and surgical care(AU)

Nurses' Perception of Patient Safety Culture in a Referral Hospital: A Cross-Sectional Study.

Healthcare systems are becoming increasingly complex which is helping to promote a 'culture of safety' within them based on the best scientific evidence available. Indeed, creating a positive institutional culture of patient safety is reflected in health outcomes. The aim of this present study was to describe the perception of culture of safety by nurses in adult inpatient units in a tertiary hospital and to analyze adverse events reporting. It was a cross-sectional study in which 202 nurses from adult hospitalization units of the Hospital Universitario y Politécnico La Fe in Valencia (Spain) participated. The perception of safety culture was measured using the Hospital Survey on Patient Safety questionnaire version 1.0, which consists of 42 items distributed in 12 dimensions that are considered strengths or weaknesses. In addition, adverse events related to nursing care during the study period and those reported in the official hospital registry were collected. Finally, the association between safety culture and sociodemographic and labor variables was explored. A total of 148 responses to the questionnaire were analyzed (Cronbach's alpha = 0.94), where seven dimensions and 25 items were identified as weaknesses. Two hundred and fourteen events were identified and none were reported in the official registry. Years of experience were significantly (p < 0.05) associated with safety culture. It is necessary to establish strategies to improve the perception of the safety culture of nurses, as well as to make nurses aware of the importance of notifying adverse events derived from health care.

Physical Persistency across Game Quarters and during Consecutive Games in Elite Junior Basketball Players.

Given the intermittent nature of basketball and the different demands that occur during playing time that are specific to every level of competition, the ratio of accelerations/decelerations and the intensity level across quarters were evaluated in female elite junior basketball players (n = 48; age: 16.8 ± 0.7 years; height: 1.76 ± 0.07 cm; body mass: 67.2 ± 6.2 kg). The following variables were analyzed to determine physical persistency across game quarters:(a) total distance covered (m), (b) high-intensity running (HIR) (14-21 km·h-1) distance covered (m), (c) sprint (21-30 km·h-1) distance covered (m), (d) total accelerations (n), (e) total decelerations (n), (f) relative accelerations (n·min-1), (g) relative decelerations (n·min-1), (h) ratio of acceleration/deceleration (A/D), (i) total jumps (j) relative jumps (n·min-1) (k) player load (AU). using the WIMU PRO® system. Higher but shorter acceleration intensity occurred during the last quarters due to the tight results of the matches. The results suggest that high-intensity efforts such as sprints and HIR seem to increase the A/D ratio (guard and forward positions). Therefore, specific conditioning, as well as eccentric strength training, could be included by practitioners in training programs to improve the performance of these positions during competition, especially as a prior preparation to a game-congested event. Centers seem to have a more variable performance through quarters than do other positions, perhaps highlighting the need for specific conditioning strategies.

New immunomagnetic separation method to analyze risk factors for Legionella colonization in health care centres.

BACKGROUND: It's pivotal to control the presence of legionella in sanitary structures. So, it's important to determine the risk factors associated with Legionella colonization in health care centres. In recent years that is why new diagnostic techniques have been developed. OBJECTIVE: To evaluate risks factors for Legionella colonization using a novel and more sensitive Legionella positivity index. METHODS: A total of 204 one-litre water samples (102 cold water samples and 102 hot water samples), were collected from 68 different sampling sites of the hospital water system and tested for Legionella spp. by two laboratories using culture, polymerase chain reaction and a method based on immunomagnetic separation (IMS). A Legionella positivity index was defined to evaluate Legionella colonization and associated risk factors in the 68 water samples sites. We performed bivariate analyses and then logistic regression analysis with adjustment of potentially confounding variables. We compared the performance of culture and IMS methods using this index as a new gold standard to determine if rapid IMS method is an acceptable alternative to the use of slower culture method. RESULTS: Based on the new Legionella positivity index, no statistically significant differences were found neither between laboratories nor between methods (culture, IMS). Positivity was significantly correlated with ambulatory health assistance (p = 0.05) and frequency of use of the terminal points. The logistic regression model revealed that chlorine (p = 0.009) and the frequency of use of the terminal points (p = 0.001) are predictors of Legionella colonization. Regarding this index, the IMS method proved more sensitive (69%) than culture method (65.4%) in hot water samples. SIGNIFICANCE: We showed that the frequency of use of terminal points should be considered when examining environmental Legionella colonization, which can be better evaluated using the provided Legionella positivity index. This study has implications for the prevention of Legionnaires' disease in hospital settings.

Validación de un cuestionario para determinar valores asociados al consumo de Maíz / Validation of a questionnaire to determine values associated with corn consumption

Se diseñó un cuestionario para investigar la intensidad de los valores asociados al consumo de maíz por mujeres amas de casa en una población urbana para poder identificar cuáles son los factores determinantes del consumo de este cereal; los resultados obtenidos muestran que el instrumento diseñado es adecuado para su uso en investigación y permite distinguir correctamente los aspectos sociales, culturales, económicos y biológicos (o de salud) que determinan el uso y consumo del maíz en la alimentación de la población. En el primer diseño del cuestionario basado en investigaciones y entrevistas previas se consideraron valores que en la primera aplicación antes de validar no eran consistentes y por ello se tuvieron que suprimir en el cuestionario validado para mantener la fiabilidad del mismo.(AU)

A questionnaire was designed to investigate the intensity of the values associated with the consumption of corn by female housewives in an urban population in order to identify what are the determinants of the consumption of this cereal; the results obtained show that the designed instrument is suitable for use in research and allows to correctly distinguish the social, cultural, economic and biological (or health) aspects that determine the use and consumption of corn in the population's diet. In the first design of the questionnaire based on previous research and interviews, values ​​that were not consistent in the first application before validating were considered and therefore had to be suppressed in the validated questionnaire to maintain its reliability.(AU)

Prevalencia de la enfermedad renal crónica y factores asociados en la población asistida en atención primaria de España: resultados del estudio IBERICAN / Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study

Objetivos: Conocer la prevalencia de enfermedad renal crónica (ERC) y determinar los factores asociados al deterioro de la función renal en población asistida en atención primaria.Pacientes y métodoEstudio transversal y multicéntrico realizado en los pacientes basales del estudio IBERICAN (identificación de la población española de riesgo cardiovascular y renal). Se consideró ERC a un filtrado glomerular estimado (FGe)<60ml/min/1,73m2 o albuminuria elevada (≥30mg/g). Según el FGe se clasificó la ERC en 6 estadios (1, 2, 3a, 3b, 4 y 5) y según la albuminuria en 3 (A1 o normal/ligeramente aumentada, A2 o moderadamente aumentada y A3 o gravemente aumentada). Se analizaron las características clínicas y la relación de la ERC con los principales factores de riesgo cardiovascular (FRCV) y otras variables de interés mediante regresión logística no condicional.ResultadosSe incluyeron 7.895 pacientes (edad media 57,9±14,8 años; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observó un aumento continuo de la prevalencia con la edad (24,8%≥65años) y con la agregación de FRCV. Las variables que más se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p<0,001), diabetes (OR: 1,58; p<0,001) e hipertensión (OR: 1,56; p<0,001).ConclusionesCatorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes≥65 años y aumenta exponencialmente con la agregación de FRCV. (AU)

Objectives: To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC).Patients and methodCross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m2 or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression.Results7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001).ConclusionsFourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV. (AU)

Prevalence of chronic kidney disease and associated factors in the Spanish population attended in primary care: Results of the IBERICAN study. / Prevalencia de la enfermedad renal crónica y factores asociados en la población asistida en atención primaria de España: resultados del estudio IBERICAN.

OBJECTIVES: To determine the prevalence of chronic kidney disease (CKD) and the factors associated with impaired renal function in the population attended in primary care (PC). PATIENTS AND METHOD: Cross-sectional and multicentre study carried out in the baseline patients of the IBERICAN study (Identificación de la poBlación Española de RIesgo CArdiovascular y reNal). CKD was considered with an estimated glomerular filtration (eGF) <60ml/min/1.73 m2 or elevated albuminuria (≥ 30mg/g). According to the eGF, the CKD was classified in six stages (1, 2, 3a, 3b, 4 and 5) and according to albuminuria in three stages (A1 or normal / slightly increased, A2 or moderately increased and A3 or severely increased). The clinical characteristics and the relationship of CKD with the main cardiovascular risk factors (CVRF) and other variables of interest were analysed using unconditional logistic regression. RESULTS: 7,895 patients were included (mean age 57.9±14.8 years; 54.5% women). 14.4% (95% CI: 13.6-15.1) had CKD; 16.1% (95% CI: 14.9-17.3) in men and 12.9% (95% CI: 11.9-14.0) in women. A continuous increase of the prevalence was observed with age (24.8% in≥65 years) and with CVFR aggregation. The variables that were most associated with the probability of suffering CKD were left ventricular hypertrophy (OR: 1.95; p <.001), diabetes (OR: 1.58; P<.001) and hypertension (OR: 1.56; P<.001). CONCLUSIONS: Fourteen out of every 100 patients included in the IBERICAN study have CKD. The prevalence of CKD affects a quarter of patients ≥ 65 years and increases exponentially with the aggregation of FRCV.

Tratamiento del aspergiloma pulmonar en paciente de alto riesgo quirúrgico: cavernostomía / Cavernostomy in the Treatment of Pulmonary Aspergilloma in a High Surgical Risk Patient

No disponible

Sequential priming in the detection of the facial expression: new approach in the study of emotional detection

The effective detection of those facial expressions that alert us to a possible threat is adaptive. Hence the reason that studies on face sampling have involved analysing how this process occurs, with evidence to show that the eyes focus mainly on the upper side of the face; nevertheless, no clear determination has been made of the relationship between the efficacy in detection (speed and accuracy) and the way in which emotions are visually tracked on the face. A sequential priming task was therefore held in which the four quadrants of the face were displayed consecutively, for 50 ms each one, and in a different order (24 sequences). The results reveal a quicker response when the priming sequence begins in the upper part, continues downward to the right-hand side of the face, and then follows an anti-clockwise direction. The results are discussed in the light of studies using the Eye-Tracking technique

La eficacia en ladetección de las expresiones faciales que nos alertan deuna posible amenaza es adaptativa. Por esta razón, los estudios sobre rastreo facial se han interesado en el análisis de este proceso, encontrándose evidenciasde quela miradase enfoca prioritariamente a la parte superior del rostro; sin embargo, no se ha establecido de manera clara la relación entre la eficacia en la detección (velocidad y precisión)y la forma en la que se rastrean las expresiones faciales emocionales. Con el objetivo de aportarclaridad en este punto, se realizó una tarea de priming secuencial en la que se mostraban los cuatro cuadrantes de la cara de manera consecutiva, durante 50 ms cada uno, y en un orden diferente (24 secuencias). Los resultados mostraron una respuesta más rápida cuando las secuencias de priming comenzaban en la parte superior, continuabanhacia abajo en el lado derecho, y posteriormente seguían la dirección contraria a la agujas del reloj. Se discuten losresultados a la luz de los estudios que utilizan la técnica de Eye-Tracking

Fibroxantoma atípico en un anciano / Atypical fibroxanthoma in an elderly

Se describe el caso clínico de un anciano de 72 años de edad, quien presentaba un tumor cutáneo dorsal maligno, por lo cual fue atendido de forma multidisciplinaria en 2 hospitales de la provincia de Santiago de Cuba. Dado el diagnóstico preoperatorio de epitelioma basocelular de piel se procedió a la extirpación del tumor de forma ambulatoria. El resultado del estudio anatomopatológico no confirmó dicho diagnóstico, pero sí corroboró que se trataba de un fibroxantoma atípico. Con los márgenes quirúrgicos de seguridad amplios se logró la curación del paciente.

The case report of a 72 years old man who presented a dorsal cutaneous neoplasm is described, reason why he was assisted in a multidisciplinary way in 2 hospitals from Santiago de Cuba. Given the preoperative diagnosis of skin basal cell epithelioma the tumor was removed in an ambulatory way. The result of the pathologic study didn't confirm this diagnosis, but it corroborated that it was an atypical fibroxanthoma. With the wide surgical margins of security the patient's cure was achieved.

Hallazgo incidental de metástasis de carcinoma de tiroides en disección de cuello por carcinoma de laringe / Incidental finding of metastasis due to thyroid´s carcinoma in a neck dissection by larynx carcinoma

RESUMEN Introducción: El fenómeno de las neoplasias primarias múltiples se ha descrito en cabeza y cuello, de forma metacrónica y sincrónica. Caso clínico: Hombre de 54 años, piel negra y procedencia rural con carcinoma escamoso de laringe T3N1M0, etapa III, que en disección de cuello se encontró incidentalmente metástasis ganglionar de carcinoma papilar de tiroides, sin evidencia clínica de lesión tiroidea. Luego se realizó ecografía y gammagrafía de la glándula cuyos resultados no mostraron alteración alguna. Conclusiones: El carcinoma de tiroides es hallado incidentalmente en el espécimen resecado después de cirugía por cáncer de cabeza y cuello en 0,3 - 1,9 por ciento de los pacientes. Por este motivo debe evaluarse bien la glándula tiroides previa cirugía de cabeza y cuello(AU)

ABSTRACT Introduction: The phenomenon of multiple primary neoplasms has been described in the head and neck in a synchronous and metachronous way. Clinical case: A 54 years old man, black skin and rural origin with a T3N1M0 larynx squamous cell carcinoma, stage III that in a neck dissection was incidentally found a node metastasis of papillary thyroid carcinoma, without clinical evidence of thyroid lesion. This was followed by ultrasound and nuclear scan of the gland, whose results did not show any alteration. Conclusions: The thyroid carcinoma is found incidentally in the resected specimen after surgery by head and neck cancer in 0.3 - 1.9 percent of patients. The thyroid gland must be well assessed after head and neck surgery(AU)

Melanoma de escroto en un paciente de mediana edad / Scrotum melanoma in a middle-age patient

Se describe el caso clínico de un paciente de 42 años de edad, de piel negra, que asistió a la consulta de Cirugía de Tumores Periféricos en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba, por presentar una lesión oscura hiperpigmentada en el lado izquierdo del escroto, próxima a la región del rafe, de aproximadamente 4 mm y bordes irregulares, que no elevaba la piel ni dolía. Se realizó exéresis de la lesión y el estudio histopatológico reveló la existencia de un melanoma, sin ulceración ni satelitosis, con crecimiento radial, por lo que se profundizó en el área operada en busca de márgenes sin afectación y se resecaron los ganglios linfáticos inguinales bilaterales de manera profiláctica. Luego se indicó quimioterapia e inyecciones de interferón. El paciente mantenía una evolución favorable hasta el año y medio después de operado.

The case report of a 42 years, black skin patient is described, he attended the Peripheral Tumors Surgery Service in Conrado Benítez García Teaching Provincial Cancer Hospital in Santiago de Cuba, due to a hyperpigmented dark lesion in the left side of the scrotum, next to the raphe region, of approximately 4 mm and irregular borders that didn't elevate the skin or hurted. An excision of the lesion was carried out and the histological and pathological study revealed the existence of a melanoma, without ulceration or satelitosis, with radial growth, reason why there was a deep examination of the operated area in search of margins without affectation and the bilateral groin lymph nodes were dried up in a prophylactic way. Then chemotherapy and interferon injections were indicated. The patient maintained a favorable clinical course until a year and a half after the surgery.

Características clinicoepidemiológicas de pacientes con cáncer de laringe / Clinical epidemiological characteristics of patients with larynx cancer

Introducción: La laringe es la localización más común de los tumores malignos de cabeza y cuello no cutáneos. Objetivo: Caracterizar a los afectados por lesiones malignas de laringe. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo de 242 pacientes con carcinoma de laringe atendidos en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba, desde enero de 2013 hasta diciembre de 2015. Resultados: La mayoría de los pacientes eran hombres (88,8 %), con una relación de 8:1 respecto al sexo femenino, y la edad media fue de 65 años. Así mismo, el tabaquismo estuvo presente en 204 pacientes (84,3 %) y los tumores glóticos resultaron ser los más frecuentes, con 168 afectados, de los cuales 89,3 % presentó como primer síntoma la disfonía, seguida en orden del aumento de volumen cervical como manifestación principal del cáncer de supraglotis (26,6 %) y de subglotis (60,0 %). El estadio predominante al momento del diagnóstico fue el I (35,5 %). Conclusiones: En la actualidad los tumores malignos de laringe resultan un importante problema de salud por la tendencia ascendente en el número de pacientes a nivel mundial.

Introduction: The larynx is the most common localization of non cutaneous head and neck malignancies. Objective: To characterize those affected patients due to larynx malignancies. Methods: A descriptive, cross-sectional and retrospective study of 242 patients with larynx carcinoma was carried out, they were assisted in Conrado Benítez García Provincial Teaching Cancer Hospital in Santiago de Cuba, from January, 2013 to December, 2015. Results: Most of the patients were men (88.8 %), with an 8:1 ratio regarding the female sex, and mean age was of 65 years. Likewise, nicotine addiction was present in 204 patients (84.3 %) and glottic tumors were the most frequent, with 168 affected, of which 89.3% presented dysphonia as first symptom, followed in order by the increase of cervical volume as main manifestation of the supraglottis (26.6 %) and subglottis (60.0 %) cancer. The predominant stage at the moment of the diagnosis was the I (35.5 %). Conclusions: At the present time larynx malignancies are an important health problem for the upward tendency in the number of patients worldwide.

Isotemporal substitution of inactive time with physical activity and time in bed: cross-sectional associations with cardiometabolic health in the PREDIMED-Plus study.

BACKGROUND: This study explored the association between inactive time and measures of adiposity, clinical parameters, obesity, type 2 diabetes and metabolic syndrome components. It further examined the impact of reallocating inactive time to time in bed, light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on cardio-metabolic risk factors, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. METHODS: This is a cross-sectional analysis of baseline data from 2189 Caucasian men and women (age 55-75 years, BMI 27-40 Kg/m2) from the PREDIMED-Plus study (http://www.predimedplus.com/). All participants had ≥3 components of the metabolic syndrome. Inactive time, physical activity and time in bed were objectively determined using triaxial accelerometers GENEActiv during 7 days (ActivInsights Ltd., Kimbolton, United Kingdom). Multiple adjusted linear and logistic regression models were used. Isotemporal substitution regression modelling was performed to assess the relationship of replacing the amount of time spent in one activity for another, on each outcome, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. RESULTS: Inactive time was associated with indicators of obesity and the metabolic syndrome. Reallocating 30 min per day of inactive time to 30 min per day of time in bed was associated with lower BMI, waist circumference and glycated hemoglobin (HbA1c) (all p-values < 0.05). Reallocating 30 min per day of inactive time with 30 min per day of LPA or MVPA was associated with lower BMI, waist circumference, total fat, visceral adipose tissue, HbA1c, glucose, triglycerides, and higher body muscle mass and HDL cholesterol (all p-values < 0.05). CONCLUSIONS: Inactive time was associated with a poor cardio-metabolic profile. Isotemporal substitution of inactive time with MVPA and LPA or time in bed could have beneficial impact on cardio-metabolic health. TRIAL REGISTRATION: The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered.