Characteristics and Therapeutic Needs of Older Patients with Oropharyngeal Dysphagia Admitted to a General Hospital.

BACKGROUND: Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome causing severe nutritional and respiratory complications. OBJECTIVE: We aimed to describe the characteristics and therapeutic needs of older patients with OD admitted to a general hospital. DESIGN, PARTICIPANTS AND MEASUREMENTS: Prospective cohort study with patients (≥70 years) with OD consecutively admitted to a general hospital. OD was clinically assessed with the Volume-Viscosity Swallowing Test and nutritional status with the Mini Nutritional Assessment-short form. Oral health (OH) and periodontal diseases were evaluated by dentists. Functionality, frailty, sarcopenia, comorbidities, dehydration, quality of life (QoL) and mortality were also assessed. RESULTS: We included 235 patients (87.3±5.5 years) with OD hospitalized for acute diseases (9.6±7.6 days). On admission, they had low functionality (Barthel: 51.3±25.1), frailty (Fried: 3.9±0.9; Edmonton: 10.3±2.7, 87.2-91.1% frail) and high comorbidities (Charlson: 3.7±2.0). Moreover, 85.1% presented signs of impaired safety and 84.7% efficacy of swallow. Up to 48% required fluid adaptation with a xanthan gum-based thickener (89.4% at 250 mPa·s; 10.6% at 800 mPa·s) and 93.2% a texture-modified diet (TMD) (74.4%, fork-mashable; 25.6%, pureed). A total of 98.7% had nutritional risk, 32.3% sarcopenia and 75.3% dehydration. OH was moderate (Oral Hygiene Index-simplified: 2.0±1.3) and 67.4% had periodontitis. QoL self-perception was 62.2% and 5.5% of patients died during hospitalization. CONCLUSION: Hospitalized older OD patients have impaired safety of swallow, frailty, malnutrition, dehydration, low functional capacity and poor OH and high risk of respiratory infections. They need a multimodal intervention including fluid thickening, TMD, thickened oral nutritional supplementation and OH care to improve health status and reduce OD-associated complications.

The 3 Minute Step Test is a validated field test to evaluate the functional exercise capacity in children aged 6 to 12.

BACKGROUND: Field tests are useful to assess the functional exercise capacity. The 6minute walking test (6MWT) is the most common field test even if alternatives are needed. The main aim of the study was to verify if the 3minute step test (3MST) is a valid tool to measure the functional exercise capacity and can surrogate the 6MWT in healthy children from 6- to 12-years-old. METHODS: This randomized cross-over trial recruited 30 healthy children from 6 to 12 years. One 6MWT and two 3MST (3MST1 and 3MST2) were performed randomly on 3 consecutive days. The variables were the distance (6MWT), the number of steps (3MST) and the cardiorespiratory parameters. RESULTS: The distance walked during 6MWT was very strongly correlated to the number of steps during the 3MST (3MST1: rho=0.833; P<0.001 and 3MST2: rho=0.868; P<0.001). Heart rate (HR) was lower than the theoretical maximal HR at the end of both tests. The change in HR and perceived fatigue were significantly higher after the 3MST. A learning effect was observed in the 3MST (+8 steps; P<0.001). CONCLUSIONS: The 3MST is validated and can be a surrogate for the 6MWT in healthy children population between 6 and 12 years old. A training test is required in these children.

Valoración del comportamiento de los apósitos de espuma polimérica Skinfoam® en el tratamiento de pacientes con úlceras vasculares venosas y análisis farmacoeconómico / Valuation of hydrophilic polymeric foam dressing Skinfoam's® behavior in the patients' treatment with vascular venous ulcers and pharmaceuticaleconomic analysis

Introducción: Las úlceras de origen vascular de las extremidades inferioresconstituyen un problema de salud, con importantes repercusiones socioeconómicasy sanitarias, así como conllevan un gran consumo de recursoshumanos y materiales. El objetivo del presente estudio fue valorarel comportamiento de los apósitos poliméricos hidrófilos de espumaSkinfoam® en el tratamiento de pacientes con úlcera vascular de etiologíavenosa, así como valorar los costes de la actividad sanitaria de dicho tratamiento.Material y métodos: Estudio observacional de series de casos clínicos,prospectivo y abierto, realizado en pacientes de ambos sexos y edadsuperior a los 18 años que presentaran, al menos, una úlcera vascular deetiología venosa susceptible de ser tratada con un apósito polimérico hidrófiloy que dieran su consentimiento informado por escrito. Las variablesanalizadas fueron la evolución de las características de la lesión duranteel tratamiento, los datos de los cambios de apósito, la valoraciónglobal del comportamiento del apósito, y el análisis de costes totales, pordía y por cm2. Los resultados del estudio se analizaron mediante una estadísticadescriptiva, expresando los resultados en medias y desviaciones estándar,y en porcentajes. Resultados: Se incluyeron 14 pacientes evaluables,con una edad media de 68 años y un 64,3% eran mujeres. El 71,4%de los pacientes presentaba úlcera vascular venosa de tipo II. Se aplicaronapósitos de espuma Skinfoam® no adhesivos en el 92,9% de los pacientes,siendo adhesivos en el 7,1% de casos (..) (AU)

Introduction: Ulcers from vascular origin of the lower extremities are a healthproblem, with important socioeconomic and sanitary consequences, as well ashigh human and material resources consumption. The aim of the present studywas to assess the performance of the hydrophilic polymeric foam dressingSkinfoam® in the treatment of patients with vascular ulcer from venous aetiology,as well as to evaluate the costs of the sanitary activity of that treatment.Material and methods: Observational study of clinical cases, prospective andopen, carried out in patients from both sex and age higher than 18 years, presentingat least one vascular ulcer of venous aetiology capable of being treatedwith an hydrophilic polymeric dressing and giving their written informed consent.The endpoints assessed were the evolution of the wound characteristics duringtreatment, the data from dressing changes, the global assessment of dressingperformance, and the cost analyses, total, per day and per cm2. Study resultswere analysed with summary statistics, showing results in mean and standarddeviations, and in percentages. Results: 14 evaluable patients were included,with a mean age of 68.0 years, and a 64.3% were females. The 71.4% of thepatients presented type II venous vascular ulcer. Non adhesive foam dressingsSkinfoam® were applied to 92.9% of patients, being adhesive in the remaining7.1% of the cases. Ulcer healing was achieved by 85.7% of the patients within2 months in average; while the remaining 14.3% didn’t achieve ulcer healing,and withdrawn the study. Global treatment assessment with foam dressingSkinfoam® was preponderantly of excellent or very good (78.6%). In the (..) (AU)

Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo / Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results

Introducción. La tromboendarterectomía (TEA) carotídeaes el procedimiento de elección para estenosis graves,especialmente si son sintomáticas, en pacientes menores de80 años. En poblaciones ancianas hay estudios que documentanla persistencia del beneficio del procedimiento; además,otros tratamientos no han demostrado tanta eficacia o sehan acompañado de frecuentes complicaciones. Este estudiodescribe las características clínicas, resultados quirúrgicosy evolución de los pacientes mayores de 75 y 80 añosintervenidos en nuestro centro en relación con los más jóvenes.Métodos. Durante los años 2000 a 2006 fueron intervenidos86 pacientes, 8 de ellos bilateralmente. Se realizaun estudio retrospectivo que describe datos relativos a lascaracterísticas clínicas y evolución de los pacientes endarterectomizados,así como comparativo entre los distintos gruposde edad.Resultados. Fueron intervenidos 26 pacientes mayoresde 75 años, de ellos 6 eran mayores de 80 años. En los pacientesmayores el factor de riesgo fundamental fue la hipertensiónarterial, hubo menor proporción de fumadores ymayor frecuencia de estenosis grave u oclusión contralateral.Las estenosis intervenidas fueron más graves y con característicasmás agresivas. No se detectó mayor comorbilidado riesgo anestésico que en los pacientes más jóvenes.Los resultados quirúrgicos, la tasa de complicaciones perioperatoriasy la evolución a corto y medio plazo fue similaren los distintos grupos de edad (morbilidad y mortalidad inmediatapor accidente isquémico transitorio, infarto cerebralo muerte: 0% en mayores de 75 años frente a 4,41%en menores de 75 años).Conclusiones. Nuestros resultados apoyan que la edadno debe considerarse una contraindicación para la realizaciónde una TEA carotídea si existe una indicación quirúrgicaclara y una morbilidad y riesgo anestésico aceptables, comoen otros grupos poblacionales (AU)

Introduction. Carotid thromboendarterectomy is thetechnique of choice for treating high-grade stenosis inpatients less than 80 years of age, especially if they aresymptomatic. Previous studies have also documented thepersistence of the benefit of the procedure in elderly populationsand, in addition, other treatments have notbeen demonstrated to be as effective or have been relatedto more frequent complications. This study describes theclinical characteristics, surgical results and outcome ofpatients older than 75 and 80 years old, treated by thromboendarterectomyin our center in comparison with ayounger population.Methods. Between the years 2000 to 2006, 86 patientswere treated by thromboendarterectomy, 8 of thembilaterally. A retrospective study that described the dataregarding clinical characteristics and outcome of the patientswho had undergone endarterectomy was conductedand the different age groups were compared.Results. Twenty-six patients older than 75 years old,6 of whom were older than 80, were operated on. In theelderly patients, the fundamental risk factor was highblood pressure, there was a lower proportion of smokersand a higher proportion of contralateral severe stenosisor occlusion. Stenosis treated by surgery was more severeand had more aggressive characteristics. Comorbidityand anesthetic risk were the same as in younger patients.Surgical results, perioperative complication rates andshort and long term outcome were similar in the differentage groups (immediate morbidity-mortality due totransitory ischemic accident, stroke or death: 0% in408 older than 75 vs. 4.41% in those under 75). Conclusions. Our results support that age should notbe considered a contraindication for the performance ofa carotid thromboendarterectomy if there is a clear indicationand acceptable morbidity and anesthetic risk, asin other population groups (AU)

[Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results]. / Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo.

INTRODUCTION: Carotid thromboendarterectomy is the technique of choice for treating highgrade stenosis in patients less than 80 years of age, especially if they are symptomatic. Previous studies have also documented the persistence of the benefit of the procedure in elderly populations and, in addition, other treatments have not been demonstrated to be as effective or have been related to more frequent complications. This study describes the clinical characteristics, surgical results and outcome of patients older than 75 and 80 years old, treated by thromboendarterectomy in our center in comparison with a younger population. METHODS: Between the years 2000 to 2006, 86 patients were treated by thromboendarterectomy, 8 of them bilaterally. A retrospective study that described the data regarding clinical characteristics and outcome of the patients who had undergone endarterectomy was conducted and the different age groups were compared. RESULTS: Twenty-six patients older than 75 years old, 6 of whom were older than 80, were operated on. In the elderly patients, the fundamental risk factor was high blood pressure, there was a lower proportion of smokers and a higher proportion of contralateral severe stenosis or occlusion. Stenosis treated by surgery was more severe and had more aggressive characteristics. Comorbidity and anesthetic risk were the same as in younger patients. Surgical results, perioperative complication rates and short and long term outcome were similar in the different age groups (immediate morbidity-mortality due to transitory ischemic accident, stroke or death: 0% in older than 75 vs. 4.41% in those under 75). CONCLUSIONS: Our results support that age should not be considered a contraindication for the performance of a carotid thromboendarterectomy if there is a clear indication and acceptable morbidity and anesthetic risk, as in other population groups.

Nutritional modulation of protein metabolism after gastrointestinal surgery.

BACKGROUND: The metabolic response to surgery includes alterations in protein metabolism, resulting in a net loss of proteins. Protein hypercatabolism is considered an unavoidable consequence of injury, and an important source of morbidity and mortality. Our purpose was to determine the effect of nutrition on protein metabolism following gastrointestinal surgery, and to elucidate whether postoperative protein loss can be prevented with adequate nutritional support. METHODS: Patients who had undergone gastrointestinal surgery were given four different parenteral nutritions with increasing glucose, lipid and amino acid content during the 7 days following surgery. Nitrogen balance, protein synthesis and protein breakdown were determined using in vivo stable isotope labelling. Other metabolites (3-methylhistidine, creatinine, urea, cortisol, glucose, insulin, amino acids and C-reactive protein) were measured. RESULTS: A nutrition-dependent alteration of protein metabolism was found in response to surgical injury. Nutrition modified nitrogen balance, whole-body protein breakdown and, to a lesser extent, whole-body protein synthesis and muscle protein breakdown. The low-energy parenteral nutrition without amino acids produced a negative nitrogen balance (postoperative day 7=-0.381 g protein kg(-1)day(-1)) and important alterations in postoperative protein metabolism that did not normalize during the study period (day 7 protein synthesis=239% and protein breakdown 217% vs preoperative). Patients receiving the two low energy parenteral nutritions containing amino acids had a less negative nitrogen balance (day 7=-0.011 and -0.133 g protein kg(-1)day(-1)) and a transient increase in protein metabolism. The complete parenteral nutrition maintained, during all studied days, protein metabolism parameters within the preoperative reference range (synthesis day 2=92%, day 4=110% day 7=79%; breakdown day 2=85%, day 4=80%, day 7=76% vs preoperative) and a positive nitrogen balance (day 2=+0.0387, day 4=+0.578 and day 7=+0.227 g protein kg(-1)day(-1)). CONCLUSION: Complete nutritional support can prevent protein loss after gastrointestinal surgery and maintain protein metabolism without alterations.

[Use of psychoactive drugs in a health and welfare centre]. / Utilización de psicofármacos en un centro sociosanitario.

OBJECTIVE: To analyse the use of psychoactive drugs in a health and welfare centre and compare this use with current guidelines. METHOD: A cross-sectional study of the drug treatment regime of hospitalised patients in a health and welfare centre was carried out. Information was obtained from prescriptions and the clinical histories of patients in the centre. The following variables were assessed: demographic data, treatment with psychoactive drugs, date of commencing treatment, dosage, drug combinations, indication and total number of drugs analysed. The results were compared with the literature and current prescription guidelines. RESULTS: 45 of the 70 patients analysed were taking psychoactive drugs: 51.1% were being treated with neuroleptic drugs, 42.2% with antidepressants, and 6.7% with anxiolytic agents. 62% were women. The overall mean age was 80.3 years old. The average number of psychoactive drugs administered to each patient was 1.6 and the average number of total drugs prescribed was 10.5. The most frequently administered psychoactive drugs were risperidone, lorazepam and citalopram. The most frequent association was neuroleptic drugs with benzodiazepine. The indication and dosage prescribed were appropriate according to the data sheet, although some inappropriate prescription practices were observed. CONCLUSIONS: The results of the study would recommend controlling the duration of treatment with benzodiazepine, confirming the diagnosis of states of depression and correctly monitoring the associations between psychoactive drugs.

Utilización de psicofármacos en un centro sociosanitario / No disponible

Objetivo: Analizar la utilización de psicofármacos en un centro sociosanitario y compararlo con las guías de recomendación existentes. Material y métodos: Se realizó un estudio transversal del perfil farmacoterapéutico de los residentes ingresados en un centro sociosanitario. Las fuentes de información fueron las prescripciones médicas y las historias clínicas del centro. Se evaluaron variables demográficas, del tratamiento con psicofármacos, fecha de inicio, dosis y combinaciones, indicación y número total de medicamentos estudiados. Se compararon los resultados con la bibliografía y las guías de prescripción existentes. Resultados: Tomaban psicofármacos 45 de los 70 pacientes estudiados observándose que el 51,1% estaban siendo tratados con fármacos neurolépticos, el 42,2% con antidepresivos, el 6,7% con ansiolíticos. El 62% eran mujeres. La edad media global fue de 80,3 años. El número medio de psicofármacos por paciente fue 1,6 y del total de medicamentos 10,5. Los psicofármacos más utilizados fueron risperidona, lorazepam y citalopram. Las asociación más frecuente fue neuroléptico más benzodiazepina. La indicación y dosis prescritas eran adecuadas según ficha técnica, aunque se observaron pautas de prescripción desaconsejadas. Conclusiones: Los resultados del estudio aconsejarían controlar la duración de los tratamientos con benzodiazepinas, asegurar el diagnóstico de los estados depresivos y realizar un adecuado seguimiento de las asociaciones entre psicofármaco

Objective: To analyse the use of psychoactive drugs in a health and welfare centre and compare this use with current guidelines. Method: A cross-sectional study of the drug treatment regime of hospitalised patients in a health and welfare centre was carried out. Information was obtained from prescriptions and the clinical histories of patients in the centre. The following variables were assessed: demographic data, treatment with psychoactive drugs, date of commencing treatment, dosage, drug combinations, indication and total number of drugs analysed. The results were compared with the literature and current prescription guidelines. Results: 45 of the 70 patients analysed were taking psychoactive drugs: 51.1% were being treated with neuroleptic drugs, 42.2% with antidepressants, and 6.7% with anxiolytic agents. 62% were women. The overall mean age was 80.3 years old. The average number of psychoactive drugs administered to each patient was 1.6 and the average number of total drugs prescribed was 10.5. The most frequently administered psychoactive drugs were risperidone, lorazepam and citalopram. The most frequent association was neuroleptic drugs with benzodiazepine. The indication and dosage prescribed were appropriate according to the data sheet, although some inappropriate prescription practices were observed. Conclusions: The results of the study would recommend controlling the duration of treatment with benzodiazepine, confirming the diagnosis of states of depression and correctly monitoring the associations between psychoactive drugs

[Clinical, functional and quality of life differences in patients of different gender with essential tremor]. / Diferencias clínicas, funcionales y de calidad de vida en pacientes con temblor esencial de ambos sexos.

INTRODUCTION: Essential tremor (ET) is a chronic disease with important variability in its clinical manifestation, discapacity and quality of life (QoL) affectation. As previous reports have described differences in clinical manifestations of ET according to gender, this study proposes to check its existence in the Spanish population and to detect the presence of discapacity or alterations in QoL between different gender. METHODS: Patients with ET attended in the neurology clinic of a sanitary area were evaluated in a prospective consecutive way. Their clinical characteristics were recorded and discapacity and QoL were assessed through the Fahn and Tolosa scale for ET and the SF-36 health questionnaire. Comparisons between groups of both genders have been established. RESULTS: 104 patients with ET were evaluated (46 males and 58 females). Clinically there were differences concerning the localization and type of tremor. Although the intensity and the presence of discapacity were similar in both genders, women showed a lower QoL compared to men in the "physical role" dimension. CONCLUSIONS: There are differences in the clinical expression and in the affectation of QoL in patients with ET of different gender. Women had a lower score in the "physical role" dimension of QoL in comparison to their reference population, meaning lesser satisfaction with their performance capacity of their usual activities. QoL, thus, does not appear in this study as something only related with the degree of discapacity, but rather as having other determinant factors.

Diferencias clínicas, funcionales y de calidad de vida en pacientes con temblor esencial de ambos sexos / Clinical, functional and quality of life differences in patients of different gender with essential tremor

Introducción. El temblor esencial (TE) es una enfermedad crónica con importante variabilidad respecto a sus manifestaciones clínicas, discapacidad y afectación de calidad de vida (CdV). Dado que estudios previos describen diferencias en las manifestaciones clínicas del TE según el sexo, se plantea este estudio para comprobar su existencia en población española y detectar la presencia de discapacidad o alteraciones en CdV en los diferentes sexos. Métodos. Se han evaluado de forma prospectiva consecutiva pacientes con TE atendidos en las consultas de neurología de un área sanitaria, registrándose sus características clínicas y valorando discapacidad y CdV mediante la escala de TE de Fahn y Tolosa y el cuestionario de salud SF-36. Se han establecido comparaciones entre ambos sexos. Resultados. Participaron 104 pacientes con TE (46 varones y 58 mujeres). Clínicamente hubo diferencias en cuanto a localización y tipo de temblor. Aunque la intensidad del temblor y la presencia de discapacidad fue similar en ambos sexos, las mujeres manifestaron menor CdV respecto a los hombres en la dimensión de «rol físico». Conclusiones. Existen diferencias en la expresión clínica y en la afectación de CdV de pacientes con TE de diferentes sexos. Las mujeres presentaron menos puntuación en la dimensión «rol físico» de CdV respecto a su población de referencia, indicando un menor grado de satisfacción con la capacidad de realización de sus actividades habituales. La CdV, por tanto, no aparece en este estudio como un aspecto relacionado solamente con el grado de discapacidad, sino que puede tener otros factores determinantes

Introduction. Essential tremor (ET) is a chronic disease with important variability in its clinical manifestation, discapacity and quality of life (QoL) affectation. As previous reports have described differences in clinical manifestations of ET according to gender, this study proposes to check its existence in the Spanish population and to detect the presence of discapacity or alterations in QoL between different gender. Methods. Patients with ET attended in the neurology clinic of a sanitary area were evaluated in a prospective consecutive way. Their clinical characteristics were recorded and discapacity and QoL were assessed through the Fahn and Tolosa scale for ET and the SF-36 health questionnaire. Comparisons between groups of both genders have been established. Results. 104 patients with ET were evaluated (46 males and 58 females). Clinically there were differences concerning the localization and type of tremor. Although the intensity and the presence of discapacity were similar in both genders, women showed a lower QoL compared to men in the «physical role» dimension. Conclusions. There are differences in the clinical expression and in the affectation of QoL in patients with ET of different gender. Women had a lower score in the «physical role» dimension of QoL in comparison to their reference population, meaning lesser satisfaction with their performance capacity of their usual activities. QoL, thus, does not appear in this study as something only related with the degree of discapacity, but rather as having other determinant factors

Improved surgical mesh integration into the rat abdominal wall with arginine administration.

Prosthetic meshes are used as the standard of care in abdominal wall hernia repair. However, hernia recurrences and side effects remain unsolved problems. The demand by health care providers for increasingly efficient and cost-effective surgery encourages the development of newer strategies to improve devices and outcomes. Here, we evaluated whether l-arginine administration was able to ameliorate long-term polypropylene prostheses incorporation into the abdominal wall of Sprague-Dawley rats. Meshes were placed on-lay and continuous l-arginine was administered. In vivo biocompatibility was studied at 7, 25 and 30 days post-implantation. Effectively, l-arginine administration in combination with mesh triggered subtle changes in ECM composition that impinged on critical biochemical and structural features. Lastly, tensile strength augmented and stiffness decreased over the control condition. This could help to restructure the mechanical load transfer from the implant to the brittle surrounding tissues, i.e., impact load and fatigue load associated with mechanical tensions could be distributed between the mesh and the restored tissue in a more balanced manner, and ultimately help to reduce the incidence of loosening, recurrences, and local wound complications. Since the newly formed tissue is more mechanically stable, this approach could eventually be introduced to human hernia repair.

Desintoxicación de alcohol y benzodiazepinas: utilidad del topiramato a altas dosis / Alcohol and benzodiazepine detoxification: utility of high-dose topiramate

Fundamento: La desintoxicación de pacientes adictos al alcohol y las benzodiazepinas suele realizarse mediante pautas de benzodiazepinas en dosis decrecientes que comportan un riesgo de recaída en adictos a benzodiazepinas y favorecen la aparición de una adicción iatrogénica en el caso de pacientes alcohólicos. El topiramato, un nuevo anticonvulsionante, ha mostrado efectos beneficiosos tanto en el control del deseo de consumo de sustancias como en el tratamiento de la desintoxicación aguda de sustancias. Revisamos nuestra experiencia en el tratamiento con topiramato en la unidad hospitalaria de desintoxicación, introducido en una pauta de escalada rápida, añadido a benzodiazepinas, como tratamiento para la desintoxicación de alcohol y/o benzodiazepinas. Comparamos, de forma retrospectiva, los efectos sobre la estancia media hospitalaria y la dosis al alta de benzodiazepinas con un grupo de pacientes tratados con una pauta estándar sin topiramato. Pacientes y Métodos: Se realizó una evaluación retrospectiva de las historias clínicas de los pacientes ingresados para desintoxicación en nuestra unidad. Se seleccionaron los casos con dependencia del alcohol y/o las benzodiazepinas. Se recogieron datos de retención en tratamiento, duración del ingreso, dosis de benzodiazepinas al alta, dosis diaria de topiramato utilizada y efectos secundarios descritos. Resultados: Un total de 65 pacientes fueron ingresados con diagnósticos de dependencia del alcohol y/o las benzodiazepinas y tratados con una pauta habitual de desintoxicación (grupo A) y 49 pacientes fueron tratados, además, con topiramato (grupo B). Diez pacientes (15,4%) interrumpieron su ingreso en el grupo A y 3 (6,1%) en el B. El análisis de los pacientes restantes mostró diferencias significativas en la estancia media hospitalaria (9,44 frente a 7 días; p < 0,001) y la cantidad de benzodiazepinas administradas al alta (68,6 frente a 29,9 mg/día de diazepam; p < 0,001). La dosis media ± desviación estándar de topiramato al alta fue de 182 ± 82 mg/día. Al segundo día de ingreso, los pacientes recibían una dosis media de 130,95 mg/día. El número de acontecimientos adversos fue bajo: 3 pacientes presentaron sedación excesiva y 1 parestesias. Conclusiones: El topiramato, como tratamiento añadido a la pauta de desintoxicación del alcohol y/o las benzodiazepinas, disminuye significativamente la estancia media y la dosis de benzodiazepinas pautadas al alta. La tolerabilidad del topiramato en dosis elevadas desde el inicio es aceptable en este tipo de pacientes. Son necesarios estudios más detallados para evaluar la eficacia y la seguridad de este tratamiento

Background: The symptomatic treatment of alcohol and benzodiazepine withdrawal is commonly performed with benzodiazepines in a decreasing titration schedule. This carries a potential risk of recurrence in benzodiazepine addicts and of iatrogenic addiction in alcoholics. Topiramate (TPM) is a novel anticonvulsant that has shown positive effects both in the control of cravings and in the treatment of acute withdrawal syndrome. We reviewed our experience of topiramate, added in a rapid-titration scheme to benzodiazepines, for the treatment of alcohol and/or benzodiazepine withdrawal syndrome in an inpatient detoxification unit. The mean length of hospital stay and benzodiazepine dose at discharge were retrospectively compared between patients treated with topiramate and a group of patients managed with standard treatment without topiramate. Methods: We retrospectively collected the medical records of all patients admitted to our detoxification unit and selected those with alcohol or benzodiazepine dependence. Data on retention, length of hospital stay, benzodiazepine doses at discharge, topiramate treatment and adverse events were recorded. Results: Sixty-five patients were admitted with a diagnosis of alcohol and/or benzodiazepine dependence and were treated with standard measures (group A), while 49 patients were treated with topiramate (group B). Ten patients (15.4%) in group A and three patients (6.1%) in group B withdrew from our Unit. Analysis of the remaining patients revealed significant differences in mean length of hospital stay (9.44 vs. 7 days, p<0,001) and benzodiazepine doses at discharge (68.6 vs. 29.9 mg/day of diazepam, p<0,001). The mean topiramate dose at discharge was 182 mg/day (SE: 82). At the second day of admission, patients were treated with a mean topiramate dose of 130.95 mg/day. Adverse events were uncommon; three patients reported excessive somnolence and one patient reported paresthesia. Conclusions: Topiramate treatment added to benzodiazepines significantly reduces the mean length of hospital stay and benzodiazepine doses at discharge in patients admitted for alcohol and/or benzodiazepine withdrawal. The rapid titration schedule of topiramate was well tolerated in these patients. More detailed studies to evaluate the safety and efficacy of topiramate for alcohol and benzodiazepine withdrawal syndrome are required

Morbilidad y mortalidad por cáncer oral y faríngeo en Chile / Morbidity and mortality for oral and pharyngeal cancer in Chile

Background: Most oral cancers are squamous cell carcinomas (90%) which are two to four times more common in men than in women. The reasons for these differences are associated with exposure to factors such as tobacco and alcohol. Age is also considered as a risk factor (about 90% of the cases are diagnosed after 45 years of age). Aim: To analyze the frequency of oral cavity cancer during the last years in Chile. Material and methods: Mortality rates were obtained from death records of the "Instituto Nacional de Estadísticas" and publications of the World Health Organization, from 1955 to 2002. Morbidity from 1969 to 2002 was obtained from hospital discharge records of the Chilean Ministry of Health. Results: Oral cancer corresponded to 1.6% of total cancer cases in Chile, with a male:female ratio of 2.3 to 1. Deaths due to oral cancer was 1% of all cancer deaths, with a male:female ratio of 2.8 to 1. The morbidity rate for both genders increased while the mortality rate was relatively constant. However, we observed an increase in the mortality rate among women from 1980 to 2002, associated with more than 100% increase in the frecuency of smoking, between 1970 and 1998. The most common anatomical location was the tongue. Conclusions: The incidences of oral cancer is increasing in Chilean women, but men are more commonly affected.

[Chronic and recurrent immune thrombocytopenic purpura]. / Púrpura trombocitopénica inmune crónica y recurrente.

BACKGROUND: Immune thrombocytopenic purpura (ITP) is characterized by a drop in platelet count usually accompanied by hemorrhagic diathesis. In chronic forms the platelet count remains low for six months after diagnosis and in recurrent forms the drop in platelet count appears after a period of normality. OBJECTIVES: To asses outcome and treatment response in patients with chronic or recurrent ITP. METHODS: We performed a retrospective, descriptive study of patients attended in the pediatric hematology outpatient clinic between January 1999 and December 2001. RESULTS: Of 38 patients with chronic ITP, 16 (42 %) presented chronic forms and 22 (58 %) presented recurrent forms. No significant differences were found between the two groups in age, sex, diagnosis, duration of follow-up, previous viral infection, or antiplatelet antibodies. In recurrent forms, the most effective treatment was intravenous immune gamma-globulin (77 % favorable responses) but response time was short (mean: 22.1 weeks). Splenectomy produced complete remission in 63 % of the chronic forms. Good results were obtained in six patients from both groups treated with intravenous anti-D immune globulin. During the study period, 4.5 % of patients with recurrent forms and 31.5 % of those with chronic forms showed spontaneous remission without treatment. CONCLUSIONS: In our experience, the most effective treatment for recurrent forms of ITP was intravenous immune globulin, but none of the treatments achieved long-term responses. In chronic forms, splenectomy is an effective alternative when the risk of hemorrhage is high, while a watchful attitude seems to be the best option when this risk is absent. Although the number of patients treated with intravenous anti-D immune globulin was low, good results were achieved.

Púrpura trombocitopénica inmune crónica y recurrente / Chronic and recurrent immune thrombocytopenic purpura

Antecedentes: La púrpura trombocitopénica inmune es un trastorno autoinmune caracterizado por un descenso de la cifra de plaquetas acompañado habitualmente de diátesis hemorrágica. Las formas crónicas son aquellas en las que la trombocitopenia persiste a los 6 meses del diagnóstico y las formas recurrentes son las que, tras un período de normalidad, experimentan un descenso en la cifra de plaquetas. Objetivos Valorar la evolución, así como la respuesta al tratamiento, de los pacientes afectados de púrpura trombocitopénica inmune crónica persistente y recurrente. Métodos Estudio retrospectivo y descriptivo de los pacientes asistidos en consultas externas en un período de 3 años, desde enero de 1999 hasta diciembre de 2001.Resultados De 38 pacientes afectados de púrpura trombocitopénica inmune crónica, 16 (42 por ciento) correspondieron a formas crónicas y 22 (58 por ciento) se consideraron formas recurrentes. No se encontraron diferencias significativas entre ambos grupos en cuanto a sexo, edad al diagnóstico, tiempo de seguimiento, infección viral previa, así como presencia de anticuerpos antiplaquetarios. En las formas recurrentes, el tratamiento médico más eficaz fue la gammaglobulina por vía intravenosa (77 por ciento de respuestas favorables), pero la duración de la respuesta fue corta (media, 22,1 semanas).El 63 por ciento de las formas crónicas persistentes obtuvieron una remisión completa mediante esplenectomía. Seis pacientes de ambos grupos, tratados con gammaglobulina anti-D, obtuvieron resultados favorables. El 4,5 por ciento de las formas recurrentes y el 31,5 por ciento de las persistentes remitieron de forma espontánea durante el período de estudio. Conclusiones Con los resultados obtenidos y en nuestra experiencia, el tratamiento más eficaz en las formas recurrentes fue la gammaglobulina intravenosa, pero ningún tratamiento consiguió respuestas duraderas a largo plazo. En las formas persistentes la esplenectomía sería una alternativa eficaz en situaciones de riesgo hemorrágico, mientras que una conducta expectante parece la mejor opción cuando éste no exista. Aunque el número de pacientes tratados es limitado es de señalar el elevado número de respuestas favorables obtenidas con la gammaglobulina anti-D (AU)

Impact of treatment on the quality of life in patients with critical limb ischaemia.

AIM: the purpose of this study was to assess the quality of life (QOL) in patients with critical lower limb ischaemia (CLI), and its modification after three types of therapeutical outcomes. MATERIALS AND METHODS: between January and December 2000 52 patients (36 male, mean age 68 years) treated for critical limb ischaemia (CLI) completed the Short Form (SF)-36 on admission and then 6 and 12 months later. Patients were divided in the 3 groups: Group I: revascularisation; Group II: major amputation; Group III: conservative treatment. Trends for each dimension over the follow-up and the effect of treatment group were assessed by an analysis of variance with repeated measurements. RESULTS: on admission, patients with CLI had a significantly worse health-related quality of life than a control population. Although some domains improved, some also deteriorated between baseline and 12 months and there was no significant difference between the three treatment groups. CONCLUSIONS: our results suggest that changes in dimensions of QOL obtained by limb revascularisation do not differ from those of other therapeutic approaches.

Injertos suprageniculares con politetrafluoroetileno. Factores que pueden influir en su permeabilidad / Above knee polytetrafluoroethylene grafts. Factors that may influence patency

Objetivo. Identificar posibles factores relacionados con la oclusión de los injertos suprageniculares de politetrafluoroetileno (PTFE). Pacientes y métodos. Estudio de 100 injertos femoropoplíteos suprageniculares de PTFE realizados en 98 pacientes (77 varones y 21 mujeres, con una edad media de 69 años; intervalo: 49-90 años). En 90 casos se indicó la revascularización por isquemia crítica de laextremidad y en 10 por claudicación intermitente. Estudio observacional retrospectivo durante un período de cinco años. Se evaluaron los parámetros siguientes: edad (mayor o menor de 65 años), sexo, factores de riesgo cardiovasculares, índice tobillo/brazo, salida distal, fibrinógeno (superior o inferior a la media de 5,7 g/ L) y celularidad sanguínea: hematocrito >45 per cent, leucocitos >10.000 y plaquetas >250.000. Para el análisis estadístico se utilizó la regresión multivariante de Cox y tablas devida Kaplan-Meier. Resultados. La permeabilidad a los 30 días fue del 99 per cent, y la acumulativa a 1, 2 y 5 años fue del 75, 56 y 41 per cent, respectivamente. El 75 per cent de las oclusiones se produjeron en los primeros 18 meses (permeabilidad del 67 per cent). En este período de 18 meses el único factor predictivo de oclusión de los injertos fue el fibrinógeno y la celularidad sanguínea (p< 0,05). A los cinco años los factores predictivos de oclusión fueron la salida distal (p= 0,01), fibrinógeno (p= 0,001) y celularidad sanguínea (p= 0,001). La permeabilidad secundaria fue del 41 per cent y el salvamento de extremidad del 82 per cent a los cinco años. Conclusión. Cifras altas de fibrinógeno y celularidad sanguínea influyen negativamente en la permeabilidad de los injertos suprageniculares de PTFE (AU)

Usefulness of short-lived proteins as nutritional indicators surgical patients.

BACKGROUND AND AIMS: Biochemical indicators are used to assess the adequacy of nutritional support given to postoperative patients. However, the metabolic alterations present in these patients diminish the efficiency of these indicators. The objective of this work is to determine the usefulness of short-lived proteins as indicators to assess the nutritional support administered to patients during the metabolic stress phase produced by surgery. METHODS: The nitrogen balance and plasma concentrations of transthyretin, retinol binding protein, and insulin-like growth factor-1 were determined in 24 patients who received 4 different nutritional regimens during 7 days after surgery. RESULTS: Transthyretin and retinol binding protein, although sensitive to nutritional intake (P<0.0005 and P<0.04 respectively), were strongly affected by the stress response (P<0.008 and P<0.0003 respectively), thus limiting their usefulness for nutrition assessment. Insulin-like growth factor-1 was not influenced by the stress response and was sensitive to the nutritional supply (P<0.0001). Insulin-like growth factor-1 was the only component that showed similar efficiency than nitrogen balance as nutritional indicator. CONCLUSIONS: Transthyretin and retinol binding protein are not adequate to assess the nutritional supply during the stress phase after surgery, while insulin-like growth factor-1 is a suitable indicator of the adequacy of recent intake in this situation, similar in performance to nitrogen balance.

Pacientes con isquemia crítica de extremidades inferiores: impacto del tratamiento en la calidad de vida / Patients with chronic ischaemia of the lower limbs: effect of treatment on quality of life

Objetivo. Determinar la calidad de vida (CV) de pacientes con isquemia crítica de miembros inferiores (ICMMII) y su modificación después de tres tipos de tratamiento.Pacientes y métodos. Durante un año (enerodiciembre de 2000) han ingresado en nuestro servicio 195 pacientes con el diagnóstico de ICMMII. De ellos, se seleccionaron los pacientes con primer episodio de ICMMII y se les propuso la realización de un test de CV (SF-36) al ingreso y a los seis meses de seguimiento. Se reclutaron 52 pacientes (36 varones y 16 mujeres), con edad media 68 años (r= 38-90). El tipo de tratamiento recibido se dividió en tres grupos (grupo I: revascularización, grupo II: amputación mayor, grupo III: tratamiento conservador), comparándose los resultados mediante el test Kruskal-Wallis. Resultados. Los 52 pacientes presentaron al ingreso una CV por debajo de la población referencial en todas las dimensiones. Hubo 30 pacientes en el grupo I, 6 en el grupo II y 16 en el grupo III, sin existir diferencias significativas en estos tres grupos en cuanto a sexo, edad, enfermedades asociadas y CV al ingreso. Al comparar la CV en los diferentes grupos a los seis meses, únicamente hubo diferencias significativas en la dimensión de función física. La media fue inferior en el grupo de amputados. Conclusión. Independientemente del tratamiento recibido, en todos los pacientes con ICMMII el tratamiento mejora la CV, en particular en la esfera física y emocional. Sólo en enfermos amputados no hay mejoría de la función física (AU)

[Incidence of infection acquired at a health center]. / Incidencia de infección adquirida en un centro sociosanitario.

BACKGROUND: Nosocomial infections in geriatric patients have specific features in geriatric health care facilities and services. The incidence of nosocomial infection in a long-term care hospital is described. PATIENTS AND METHOD: The study was carried in L'AlianCa from Barcelona, a long-term care hospital of 138 beds of geriatric rehabilitation or convalescence. All nosocomial infections occurred in 1999 were recorded. The criteria of nosocomial infection were those of McGeer, adapted to make them suitable to a long-term care hospital. The statistical methods employed were the Student'st test to compare means and chi2 to compare proportions. RESULTS: The incidence of nosocomial infections was 2.8 per 1,000 resident care days, showing a statistically significant increase in the group aged over 75 (p = 0.009). Infected patients had longer hospital stay and greater physical dependence. Lower respiratory tract infections were the most common type of infection accounting for the 39.7% of the cases. The mortality rate was greater in the infected group (RR: 2.61; CI 95%, 1.60-4.25). CONCLUSIONS: Elderly patients are at greater risk of contracting nosocomial infections. It is necessary to develop infection control programs useful for the long-term care hospital.