Effect of Physical Exercise Programs Based on Mobile Health and Ecological Momentary Assessment on the Physical and Mental Health, Cognitive Functions, and Social Environment of Adults in Developing Countries: A Systematic Review.

Background and Objectives: Although there is strong evidence of the positive effects of physical exercise on health, adherence to face-to-face exercise programs in the adult population is low, identifying several barriers that hinder their practice. There is research that demonstrates the viability of physical exercise programs with the use of Mobile Health in Ecological Momentary Assessment (EMA) mode, which contributes to overcoming many reported barriers. To synthesize the methodological characteristics and health effects of physical exercise programs based on mobile health in EMA modality in adults in developing countries. Materials and Methods: This systematic review was conducted according to guidelines established by the PRISMA statement in APA PsycArticles and CINAHL databases by EBSCOhost, Cochrane Library, PubMed, and Web of Science for articles published between 2008 and March 2024. Results: Telephone counseling on clinical-behavioral factors is believed to reduce morbidity and mortality in developed countries, but this aspect is not explored in developing countries. We included nine randomized controlled trials with a total of 4394 male and female participants aged 18 to 60 years. The interventions were mainly carried out by text messages, lasting between 20 to 80 min per session, 3 to 5 days per week, and most were carried out over 12 months. The interventions on the variables of physical activity, nutrition, and medical assessments showed significant effects, and variables such as quality of life and anthropometric measurements were not significant in most studies. Conclusions: This systematic review included studies from different developing countries, the most common diseases being diabetes, overweight, obesity, and hypertension. All the studies used mobile devices as the technology, finding a profile of the adults studied, as well as the characteristics of exercise programs based on mobile health in EMA modality.

Effects of a remotely supervised resistance training program on muscle strength and body composition in adults with cystic fibrosis: Randomized controlled trial.

INTRODUCTION: Among the limited studies on physical exercise interventions in adults with cystic fibrosis (CF), few have specifically addressed the improvement of peripheral muscle strength and body fat-free mass. The aim of this study was to examine the impacts of a remotely supervised, individualized 8-week resistance training program of moderate to high intensity on strength and body composition in these subjects. METHODS: This was a randomized controlled trial performed in adults with CF. The exercise group (EX) performed three 1-h resistance training sessions per week over 8 weeks. The control group (CON) followed the physical activity recommendations of their physician. The main outcomes were muscle strength and body composition, with secondary measures including pulmonary function and quality of life. Two-way repeated measures analysis was used. RESULTS: In 23 participants (age 32.13 ± 7.72 years), the intervention showed a significant beneficial effect on leg press strength, with a large effect size, both in absolute (p = 0.011; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.281) and relative (p = 0.007; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.310) terms. Large intervention effects were observed on total fat mass (p < 0.001; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.415), body adiposity index (p < 0.001; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.436), and fat mass index (p < 0.001; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.445), all showing reduction in the EX group. In addition, significant large size effects were detected on total fat-free mass (p = 0.046; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.177), trunk fat-free mass (p = 0.039; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.188), and fat-free mass index (p = 0.048; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.174), all favoring exercise. No significant effects were observed on pulmonary function and quality of life. CONCLUSIONS: An 8-week remotely supervised resistance training program, with moderate to high intensity, effectively improved lower limb muscle strength and body composition.

Correlation between late gadolinium enhancement sequences in MRI and pathologic response after neoadjuvant chemotherapy in breast cancer / Correlación entre secuencias de realce tardío de gadolinio en RM y respuesta patológica tras quimioterapia neoadyuvante en cáncer de mama

Objectives: To study the correlation between radiologic response observed by late enhancement sequences in MRI and pathologic response after neoadjuvant chemotherapy in patients with breast cancer. Material and methods: Retrospective observational study of 132 patients with 136 tumors (4 with bilateral disease), treated consecutively with neoadjuvant chemotherapy at our institution between 2011 and 2017. In all cases, we performed 3 breast MRI's, using late enhancement gadolinium sequences: the first prior to neoadjuvant chemotherapy, the second half way through treatment, and the third at the completion of therapy. Following treatment, contrast medium uptake in tumor bed was evaluated based on the Response Evaluation Criteria for Solid Tumors (RECIST). All patients underwent conservative or radical surgery. We compared the radiologic response estimated by MRI, with the pathologic response observed in the surgical specimen, according to Miller and Payne grading system. We calculated the sensitivity, specificity, and predictive values of the test, and used the Spearman correlation coefficient to stablish correlations between the parameters analyzed. Results: Complete pathologic response (pCR) was observed in 58.1% (79/136). The percentage of global radio-pathologic correlation was 88.97%. MRI showed a sensitivity of 78.9%, a specificity of 79.7%, a positive-predictive value (PPV) of 73.8% and a negative-predictive value (NPV) of 84%. In patients with partial response, the Spearman correlation was positive (rho = 1, P < .001). According to surrogate subtypes of breast cancer, we observed moderate correlation for luminal tumors (rho = 0.63, P < .001) and poor correlation for non-luminal types (rho = 0,4, P < .01). (AU)

Objetivos: Estudiar la correlación entre la respuesta radiológica observada mediante secuencias de realce tardío en resonancia magnética y la respuesta patológica después de quimioterapia neoadyuvante en pacientes con cáncer de mama. Material y métodos: Estudio observacional retrospectivo de 132 pacientes con 136 tumores (cuatro con enfermedad bilateral), tratados consecutivamente con quimioterapia neoadyuvante en nuestra Institución entre 2011 y 2017. En todos los casos se realizaron tres resonancias magnéticas de mama, utilizando secuencias de realce tardío de gadolinio: la primera antes de la quimioterapia neoadyuvante, la segunda a mitad del tratamiento y la tercera al finalizar la terapia. Después del tratamiento, la captación media de contraste en el lecho tumoral se evaluó en función de los Criterios de Evaluación de la Respuesta para Tumores Sólidos (RECIST). Todas las pacientes se sometieron a cirugía conservadora o radical. Comparamos la respuesta radiológica estimada por resonancia magnética, con la respuesta patológica observada en la pieza quirúrgica, valorada según clasificación de Miller y Payne. Se calcularon sensibilidad, especificidad, valores predictivos y correlacion de Spearman para establecer correlaciones entre los parametros analizados. Resultados: Se observó respuesta patológica completa (pCR) en el 58,1% (79/136). El porcentaje de correlación radiopatológica global fue del 88,97%. La RM mostró una sensibilidad del 78,9%, una especificidad del 79,7%, un valor predictivo positivo (VPP) del 73,8% y un valor predictivo negativo (VAN) del 84%. En pacientes con respuesta parcial, la correlación de Spearman fue positiva (rho = 1, p < 0,001). De acuerdo con los tipos subrogados de cáncer de mama, observamos una correlación moderada para los tumores luminales (rho = 0,63, p < 0,001) y una correlación deficiente para los tipos no luminales (rho = 0,4, p < 0,01). (AU)

White-Matter Lesions and Cortical Cerebral Blood Flow Evaluation by 3D Arterial Spin-Labeled Perfusion MRI in Asymptomatic Divers: Correlation with Patent Foramen Ovale Ocurrence.

Cerebral white-matter lesions (cWML) can be caused by dilation of Virchow-Robin spaces or may correspond to true lacunar ischemic lesions. The aim of our study was to evaluate in asymptomatic divers the relationship between the presence of patent foramen ovale (PFO) and cWML, as well as their possible effects on cortical cerebral blood flow (CBF) by magnetic resonance (MRI) through the arterial spin labeling (ASL) sequence. Transthoracic echocardiography was performed for the identification of PFO, and cerebral magnetic resonance including the 3D-ASL sequence for CBF quantification. Thirty-eight divers, with a mean age 45.8 ± 8.6 years, were included. Nineteen healthy volunteers, mean age 41 ± 15.2 years, served as the control group. A total of 28.9% of divers had completed more than 1000 dives. It was found that 26.3% of divers presented with PFO in the echocardiographic study. cWML was evidenced in 10.5% of diver MRI studies. There was no statistically significant relationship between the presence of PFO and cWML (p = 0.95). We observed a lower blood flow in all brain areas assessed by the 3D-ASL sequence in the group of divers, compared with the control group. We did not find statistical differences in CBF as a function of the presence or absence of PFO, number of dives, or cWML evidence.

Telemedicine in pulmonary rehabilitation - benefits of a telerehabilitation program in post-COVID-19 patients: a controlled quasi-experimental study.

INTRODUCTION: COVID-19 pandemic has challenged healthcare systems worldwide. The aim of this study was to assess the results of a Respiratory Telerehabilitation Program implemented to patients post-COVID-19 in postacute phase of mild to critical course of COVID-19 who had persistent respiratory symptoms and had not received any vaccination. The intervention was performed during confinement. METHODS: A quasi-experimental nonrandomized study was conducted in Spain during confinement. Respiratory Telerehabilitation Program was guided by a specialized physical therapist through a web platform (Zoom by Zoom Video Communications, San Jose, CA, USA). Participants were recruited through social webs. Outcome measures included respiratory rate, heart rate, percutaneous oxygen saturation, Mahler's Dyspnea Index, anxiety status, and quality of life [EuroQol 5 Dimension 5 (EQ-5D)]. RESULTS: A total number of 148 participants were recruited, with a final number of 100 participants completing the protocol (50 experimental group (EG)/50 control group (CG)). A total of 500 telerehabilitation sessions were performed for this study. In the EG, pre-post intervention comparative analysis showed significative changes in Mahler's functional dyspnea (p < 0.001), the State-Trait Anxiety Inventory (p < 0.001), oxygen saturation (p < 0.001), heart rate (p < 0.001), quality-of-life questionnaire (p < 0.001), and respiratory rate (p < 0.001). Participants in the CG showed an improvement in all the variables, but the differences were not statistically significant except in Mahler's functional dyspnea (p = 0.001) and in the quality-of-life questionnaire (p = 0.043). Percentage changes in pre-post intervention were calculated and compared between EG and CG. There were statistically significative differences in all the outcomes in favor of the EG. CONCLUSION: The implementation of a pulmonary telerehabilitation program for COVID-19 not vaccinated survivors in postacute phase with mild to critical course of COVID-19 with respiratory sequelae has proven its benefits in cardiorespiratory variables and dyspnea-related anxiety.

Digitized Prenatal Newsletter: Impact on Obstetric Patient Satisfaction and Loyalty.

The high demand for health information from pregnant women has encouraged the creation of an informative program through a weekly digital newsletter. The objective of this study is to evaluate its quality as a digital communication medium, in terms of satisfaction and loyalty to the pregnancy follow-up and delivery service. A cross-sectional, prospective study was carried out, surveying 179 patients by means of an online self-referral questionnaire including variables related to humanization, information needs, perceived accompaniment and satisfaction, as well as factors related to its influence on their decision to remain loyal to the center. A total of 81.2% of the participants showed high levels of satisfaction with the program. Satisfaction among nulliparous patients was significantly lower in several aspects. The resolution of doubts and the perception of peace of mind following the information received was positive for 54.8%. Of the patients in the program, 88.8% finally remained at the center, showing a strong influence of the program on their decision (mean value 75 on 1 to 100 scale). A weekly digital newsletter with specific information reduced the demand for information from pregnant women, generating high levels of satisfaction and positively influencing the decision to remain loyal to the Center.

Influence of unstable shoes on women with lumbopelvic postpartum pain: randomized clinical trial

ABSTRACT BACKGROUND: Back pain is a normal symptom during pregnancy and is expected to become worse beyond the first three months after childbirth. OBJECTIVES: To determine the effectiveness of wearing unstable shoes instead of conventional shoes, regarding pain intensity, low back mobility and stability, among women with lumbopelvic pain (LPP) during the postpartum period. DESIGN AND SETTING: Prospective, single-blinded, randomized clinical trial conducted at a podiatry and physiotherapy clinical center. METHODS: A nine-week program of wearing either unstable shoes (A) or conventional shoes (B) was implemented. The following outcomes were measured in three assessments: pain intensity, using a visual analogue scale (VAS); low-back mobility, using a modified Schober test; and stability, using a pressure platform. RESULTS: The lateral stability speed, anterior stability speed and anterior center of pressure (COP) showed significant (P < 0.05) decreases in the unstable shoes group after nine weeks, in relation to the conventional group. Intra-group measurements showed significant differences (P < 0.05) in VAS between the second and third assessments and between the first and third assessments in both groups. Intra-group evaluations also showed statistically significant differences (P < 0.05) in the lateral stability speed and anterior stability speed. CONCLUSIONS: Unstable shoes were effective in decreasing the pain intensity at five and nine weeks in women with postpartum LPP. In addition, their use produced decreases in lateral stability speed, anterior stability speed and anterior COP at nine weeks.

Influence of unstable shoes on women with lumbopelvic postpartum pain: randomized clinical trial.

BACKGROUND: Back pain is a normal symptom during pregnancy and is expected to become worse beyond the first three months after childbirth. OBJECTIVES: To determine the effectiveness of wearing unstable shoes instead of conventional shoes, regarding pain intensity, low back mobility and stability, among women with lumbopelvic pain (LPP) during the postpartum period. DESIGN AND SETTING: Prospective, single-blinded, randomized clinical trial conducted at a podiatry and physiotherapy clinical center. METHODS: A nine-week program of wearing either unstable shoes (A) or conventional shoes (B) was implemented. The following outcomes were measured in three assessments: pain intensity, using a visual analogue scale (VAS); low-back mobility, using a modified Schober test; and stability, using a pressure platform. RESULTS: The lateral stability speed, anterior stability speed and anterior center of pressure (COP) showed significant (P < 0.05) decreases in the unstable shoes group after nine weeks, in relation to the conventional group. Intra-group measurements showed significant differences (P < 0.05) in VAS between the second and third assessments and between the first and third assessments in both groups. Intra-group evaluations also showed statistically significant differences (P < 0.05) in the lateral stability speed and anterior stability speed. CONCLUSIONS: Unstable shoes were effective in decreasing the pain intensity at five and nine weeks in women with postpartum LPP. In addition, their use produced decreases in lateral stability speed, anterior stability speed and anterior COP at nine weeks.

Endometriosis torácica como causa de neumotórax espontáneo recurrente en mujer de 53 años / Thoracic endometriosis presenting as recurrent spontaneous pneumothorax in a 53-year-old female

Una mujer de 53 años asintomática es diagnosticada de tercer episodio de neumotórax en hemitórax derecho. En episodios previos no se había objetivado causa del neumotórax salvo bullas subpleurales. Una videotoracoscopia muestra lesiones típicas de endometriosis torácica junto con múltiples perforaciones diafragmáticas. Tras la reparación quirúrgica la paciente recibió tratamiento anti-estrogénico con buena evolución. Se trata de un caso excepcional por su forma de presentación, por la edad de la paciente y por la afectación diafragmática. (AU)

A 53-year-old asymptomatic female presented with a third episode of spontaneous pneumothorax in right hemithorax. Previous studies did not demonstrate the etiology of this disease but only sub-pleural bullae. We found typical thoracic endometriosis lesions through video thoracoscopy. After surgical correction and anti-estrogenic treatment, the patient remains asymptomatic. This case is relevant due its presentation, diaphragmatic involvement and the age of the patient. (AU)

Conocimiento de la composición y efectos secundarios de las bebidas energéticas en alumnos de medicina: estudio transversal / Knowledge of energy drinks composition and side effects in medical students: a cross-sectional study

INTRODUCCIÓN: En los últimos 20 años se ha producido un incremento del consumo de bebidas energéticas, con un alto contenido de cafeína, en especial en la población de adolescentes. Pocos estudios han investigado qué saben los estudiantes de medicina sobre este producto y sus posibles efectos secundarios. SUJETOS Y MÉTODOS: Estudio observacional y transversal. Se incluyeron todos los alumnos de primer y segundo curso de medicina en la Universidad Europea de Madrid en los cursos 2017-2018 y 2018-2019. Se elaboró una encuesta con 20 ítems: 7 preguntas sobre datos sociodemográficos y de estilo de vida y 13 sobre conocimiento y hábitos de consumo de bebidas energéticas. Los alumnos cumplimentaron la encuesta de forma voluntaria, anónima y autoadministrada Se realizó una estadística descriptiva y para la comparación de variables cualitativas se utilizó la prueba de chi cuadrado o el test exacto de Fisher. RESULTADOS: Respondieron a la encuesta 353 alumnos (80% de la muestra). De ellos, 115 (32,6%) señalaron que consumían al menos una lata al mes (consumidores). El 79% conocían algún componente: el 67,1%, que contenían taurina; el 51,9%, cafeína, y el 31,2%, azúcares. En cuanto a los efectos secundarios derivados del consumo, los más conocidos eran taquicardia/palpitaciones, insomnio, nerviosismo e irritabilidad e incremento de la diuresis. CONCLUSIONES: Los alumnos de primer y segundo de medicina conocen mayoritariamente que las bebidas energéticas contienen taurina, pero solo la mitad, que contienen cafeína. Los efectos secundarios más conocidos son la sensación de palpitaciones/taquicardia y la dificultad para dormir

INTRODUCTION: The consumption of energy drinks, drinks with a high caffeine content, has increased exponentially in the last decade. Several studies have been carried out especially in the adolescent population, but there are not many studies in medical students. SUBJECTS AND METHODS: Observational and cross-sectional study where all students of 1st and 2nd year of Medicine at Universidad Europea de Madrid were included in the 2017-2018 and 2018-2019 academic years. A questionnaire was done with 20 items: 7 questions about sociodemographic and lifestyle aspects and 13 questions about knowledge and consumption habits of energy drinks. Questionnaire fill in was voluntary, anonymous and self-administered. A descriptive statistic analysis was performed and squared chi test or Fisher's exact test was used for the comparison of qualitative variables. RESULTS: 353 students (80%) filled in the questionnaire. 115 of them (32.6%) indicated that they consumed at least one can per month (consumers). 79% knew at least one components of these drinks: 67.1% said they contained taurine, 51.9% caffeine and 31.2% sugars. Best known side effects were tachycardia/palpitations, insomnia, nervousness and irritability and increased diuresis. CONCLUSIONS: Most of 1st and 2nd year medical students knows that energy drinks contain taurine but only half of them knows they contain caffeine. Best known side effects are: palpitations/tachycardia and difficulty sleeping

Biopsia selectiva de ganglio centinela tras quimioterapia neoadyuvante en pacientes con axila negativa al inicio / Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with negative axillary involvement at initial diagnosis

OBJETIVO: valorar la tasa de detección de ganglio centinela tras quimioterapia neoadyuvante en pacientes con cáncer infiltrante de mama y axila clínicamente negativa previa al tratamiento y analizar su supervivencia global y supervivencia libre de enfermedad. MATERIAL Y MÉTODOS: estudio observacional retrospectivo. Se incluyeron las pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante en el Hospital Universitario Quironsalud Madrid entre los años 2008-2014. A todas se les practicó cirugía conservadora o radical junto con biopsia selectiva de ganglio centinela posneoadyuvancia. Se recogió información correspondiente a características sociodemográficas, variables relacionadas con el tratamiento quirúrgico y médico, evolución, características del tumor, supervivencia global y supervivencia libre de enfermedad. RESULTADOS: se incluyeron en el estudio 112 pacientes (116 tumores, 4 de ellos bilaterales). De los 112 tumores unilaterales, 98 (84,5%) estaban en estadios iniciales. La mediana de tamaño tumoral fue 20 mm (15-30). La práctica totalidad (97,4%) eran carcinomas ductales infiltrantes. La quimioterapia se basó en antraciclinas y taxanos con adición de carboplatino en los casos triple negativo y de trastuzumab en Her-2/neu sobreexpresado. Se realizó cirugía conservadora en el 59,5%. La tasa de detección de ganglio centinela fue del 100% con un valor predictivo negativo del 99,1% (110/111), al encontrar una sola recidiva axilar en los 111 ganglios centinela negativos, y se obtuvo respuesta completa patológica en el 52,6%, mayoritariamente en los tumores Her-2 puros y triples negativos con diferencia estadísticamente significativa (p:0.018). La supervivencia global fue del 99,1% con mediana de seguimiento de 53 meses, observando eventos de recaída en 10 pacientes de las cuales solo 2 fueron axilares. CONCLUSIONES: en nuestra experiencia, la biopsia selectiva de ganglio centinela sistemática posneoadyuvancia en pacientes con axila negativa al inicio presenta una excelente tasa de detección, sin aumentar el número de recidivas axilares de forma significativa ni la supervivencia global de estas pacientes. Consideramos, por tanto, esta estrategia la mejor opción para la estadificación quirúrgica de estos tumores

OBJECTIVE: To assess sentinel lymph node biopsy rate after neoadjuvant chemotherapy in breast cancer patients with negative axillary nodes at diagnosis and to analize their disease free interval and overall survival. MATERIAL AND METHODS: Retrospective observational study including breast cancer patients with neoadjuvant chemotherapy at the Hospital Universitario Quironsalud Madrid between 2008-2014. Post chemotherapy, all patients underwent conservative or radical surgery along with a systematic sentinel lymph node biopsy. Patients data was collected and included sociodemographic characteristics, variables regarding surgical and medical treatment, follow-up, tumor characteristics, overall and disease-free survival. RESULTS: The study included 112 patients (116 tumors, 4 of them bilateral). Of the 112 unilateral tumors, 98 (84.5%) were early stages. The median tumor size was 20 mm (15-30) and the majority (97,4%) were invasive ductal carcinoma chemotherapy was based on anthracyclines and taxanes with addition of carboplatin in triple negative cases and trastuzumab in Her-2/neu positive tumors. Conservative procedures were performed in 59,5% of cases. Sentinel lymph node detection rate reached 100% with a negative predictive value of 99,1% (110/111) finding only one axillary recurrence among 111 SLNB. We achieved pathological complete response in 52,6% of tumors in the breast, and more specifically in pure Her2/neu positive and triple negative surrogates (p:0.018). Overall survival was 99,1% with median follow-up of 53 months and 10 patients had a relapse, with only two patients with axillary involvement. CONCLUSIONS: In our experience, sentinel lymph node biopsy performed systematically after neoadjuvant treatment in clinically node negative patients have an excellent detection rate without increasing the axillary recurrence rate nor decreasing overall survival in this group of patients. We consider this strategy the best option for the surgical staging of this tumors after chemotherapy

Diagnosis of invasive fungal disease in hospitalized patients with chronic obstructive pulmonary disease / Diagnóstico de micosis invasora en pacientes hospitalizados con enfermedad pulmonar obstructiva crónica

Background: The role of culture-independent techniques (galactomannan, (1-3)-ß-d-glucan) in the early diagnosis of invasive fungal diseases (IFD) is well assessed in hematological patients, but there are no clear conclusions in patients with chronic obstructive pulmonary disease (COPD). Aims: To study the usefulness of nonculture-based techniques in the diagnosis of IFD in COPD-patients at risk for IFD. Methods: A prospective observational study based on monitoring COPD patients at risk for IFD during 2007-2010 was carried out. The presence of galactomannan, (1-3)-ß-d-glucan and an indirect immunofluorescence of Candida albicans germ tube specific antibodies (CAGTA) were performed. Results: Among 43 COPD patients, 16 (37.2%) were diagnosed with IFD: seven cases were proven IFD (five invasive candidemia - IC, one invasive aspergillosis - IA and a rhinocerebral zygomycosis) and nine probable IFD (seven IA and two IC). In the diagnosis of IC and IA, the negative predictive value (NPV) of (1-3)-ß-d-glucan was 100%. Regarding CAGTA in IC, NPV was 96.2%. Finally, NPV of galactomannan in IA was 91.2%. The area under the ROC curve for (1-3)-ß-d-glucan in IC and for the rest of the IFD cases was 0.86 (95% CI, 0.79-0.93) and 0.60 (95% CI, 0.43-0.77), for CAGTA in IC was 0.83 (95% CI, 0.74-0.91) and for galactomannan in IA was 0.71 (95% CI, 0.56-0.85). Positive (1-3)-ß-d-glucan preceded the growth of Candida (average of 1.7 days) in blood culture. Conclusions: In COPD patients at risk for IFD the assayed techniques are especially useful to rule out the presence of IFD

Antecedentes: El papel de las técnicas independientes de cultivo [galactomanano, (1-3)-ß-D-glucano] en el diagnóstico precoz de micosis invasoras (MI) está bien establecido en pacientes hematológicos, pero no existen conclusiones claras en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Objetivos: Estudiar la utilidad de las técnicas independientes de cultivo en el diagnóstico de MI en pacientes con EPOC que corren el riesgo de contraer una MI. Métodos: Se llevó a cabo un estudio prospectivo y observacional en que se supervisaron pacientes con EPOC que corrían el riesgo de contraer una MI de 2007 a 2010. Para ello se estableció la existencia de galactomanano, (1-3)-ß-D-glucano y se realizó el ensayo CAGTA (inmunofluorescencia indirecta para determinar la existencia de anticuerpos IgG frente a antígenos de la superficie de la fase micelial de Candida albicans). Resultados: Se diagnosticaron 16MI en 43pacientes con EPOC (37,2%): siete fueron MI probadas (cinco candidemias invasoras [CI], una aspergilosis invasora [AI] y una cigomicosis rinocerebral) y nueve fueron MI probables (siete AI y dos CI). En el diagnóstico de CI y AI, el valor predictivo negativo (VPN) del (1-3)-ß-D-glucano fue del 100%. En cuanto al CAGTA en CI, el VPN fue del 96,2%. Finalmente, el VPN del galactomanano en AI fue del 91,2%. El área bajo la curva ROC (receiver operating characteristic) del (1-3)-ß-D-glucano en CI y en el resto de los casos de MI fue 0,86 (IC95%=0,79-0,93) y 0,60 (IC95%=0,43-0,77), para CAGTA en CI fue 0,83 (IC95%=0,74-0,91) y para galactomanano en AI fue 0,71 (IC95%=0,56-0,85). La positividad del (1-3)-ß-D-glucano se anticipó como media 1,7días al crecimiento de Candida en el hemocultivo. Conclusiones: En pacientes con EPOC que corren el riesgo de contraer MI, estas técnicas son muy útiles para descartar la existencia de MI

Ecografía automática de mama para la detección de lesiones mamarias: Comparación con la ecografía mamaria convencional / Automated breast ultrasound for the detection of breast lesions: comparison with hand-held ultrasound

Objetivos: Comparar la ecografía convencional frente a la ecografía automática de mama (ABUS) y la mamografía con tomosíntesis aislada en la detección y el diagnóstico de lesiones mamarias. Sujetos y métodos: Se incluyeron 155 mujeres sintomáticas y asintomáticas con mamas densas. Todas se realizaron mamografía y seguidamente ecografía manual y ABUS, que fueron interpretadas por 2 radiólogos diferentes. Los estudios fueron categorizados según el Breast Imaging Reporting and Data System (BI-RADS). Resultados: El índice kappa de concordancia fue de 0,83, p<0,05. Los 5 carcinomas encontrados fueron diagnosticados por ambas técnicas de imagen de ultrasonidos, siendo en 2 de ellos la mamografía normal. ABUS detectó 2 lesiones benignas no vistas con la ecografía manual. Conclusión: ABUS demostró alta correlación con la ecografía manual detectando más lesiones benignas. El diagnóstico de las malignas fue equivalente con ambas técnicas, que fueron superiores a la mamografía de forma aislada. ABUS podría sustituir a la ecografía manual para complementar a la mamografía en la detección de cáncer de mama en mujeres con mama densa

Objectives: To compare automated breast ultrasound (ABUS) with hand-held ultrasound (HHUS) and tomosynthesis mammography in the detection and characterisation of breast lesions. Subjects and methods: A total of 155 symptomatic and asymptomatic women with dense breasts underwent tomosynthesis followed by ABUS and HHUS. The studies were read and graded by two different radiologists according to the Breast Imaging Reporting and Data System (BI-RADS). Results: The kappa index of agreement was 0.83, p<0.05. All of the 5 carcinomas found were diagnosed by ABUS and HHUS. Tomosynthesis was normal in 2 out of 5 cases. ABUS identified 2 benign lesions not detected with HHUS. Conclusion: This study found a high correlation between ABUS and HHUS. More benign lesions were identified by ABUS while malignant lesions were detected equally by both techniques. ABUS and HHUS were superior to tomosynthesis in the detection of lesions. ABUS could replace HHUS, complementing mammography in the detection of lesions in women with dense breasts

Diagnosis of invasive fungal disease in hospitalized patients with chronic obstructive pulmonary disease.

BACKGROUND: The role of culture-independent techniques (galactomannan, (1-3)-ß-d-glucan) in the early diagnosis of invasive fungal diseases (IFD) is well assessed in hematological patients, but there are no clear conclusions in patients with chronic obstructive pulmonary disease (COPD). AIMS: To study the usefulness of nonculture-based techniques in the diagnosis of IFD in COPD-patients at risk for IFD. METHODS: A prospective observational study based on monitoring COPD patients at risk for IFD during 2007-2010 was carried out. The presence of galactomannan, (1-3)-ß-d-glucan and an indirect immunofluorescence of Candida albicans germ tube specific antibodies (CAGTA) were performed. RESULTS: Among 43 COPD patients, 16 (37.2%) were diagnosed with IFD: seven cases were proven IFD (five invasive candidemia - IC, one invasive aspergillosis - IA and a rhinocerebral zygomycosis) and nine probable IFD (seven IA and two IC). In the diagnosis of IC and IA, the negative predictive value (NPV) of (1-3)-ß-d-glucan was 100%. Regarding CAGTA in IC, NPV was 96.2%. Finally, NPV of galactomannan in IA was 91.2%. The area under the ROC curve for (1-3)-ß-d-glucan in IC and for the rest of the IFD cases was 0.86 (95% CI, 0.79-0.93) and 0.60 (95% CI, 0.43-0.77), for CAGTA in IC was 0.83 (95% CI, 0.74-0.91) and for galactomannan in IA was 0.71 (95% CI, 0.56-0.85). Positive (1-3)-ß-d-glucan preceded the growth of Candida (average of 1.7 days) in blood culture. CONCLUSIONS: In COPD patients at risk for IFD the assayed techniques are especially useful to rule out the presence of IFD.

Triage de urgencias médicas: diferencias entre población inmigrante y autóctona en un hospital madrileño / Triage in medical emergencies: differences between immigrant and native populations in a hospital in Madrid

OBJETIVOS: determinar las causas más frecuentes de requerimiento de asistencia urgente hospitalaria y su gravedad comparando y analizándolas diferencias entre la población autóctona y la población inmigrante. MATERIAL Y MÉTODO: estudio descriptivo transversal realizado en varios turnos de urgencia hospitalaria durante doce meses (julio 2011- julio2012) del Hospital de Móstoles (Madrid). Variables de estudio: sexo, edad, país de origen, MTS (Manchester Triage System), motivos de consulta, tener tarjeta sanitaria y haber acudido previamente a Atención Primaria. RESULTADOS: se estudiaron 238 pacientes: 190 autóctonos y 48 inmigrantes. La mayoría de los inmigrantes (54%) procedían de Latinoamérica. El MTS más habitual fue el verde (urgencia estándar) (51,7%).Se encontraron diferencias estadísticamente significativas en cuanto a la edad (el grupo de inmigrantes era más joven), y en el motivo de consulta (los autóctonos acudieron por más problemas cardiológicos)pero no respecto al sexo, el MTS ni en asistencia previa al médico de Atención Primaria. CONCLUSIONES: los pacientes inmigrantes que acuden al servicio de urgencia del Hospital de Móstoles tienen la misma gravedad (según MTS) que los autóctonos. La población inmigrante que acude a urgencias es más joven, y la autóctona lo hace en mayor proporción por sintomatología cardiológica. Más del 70% en ambas poblaciones no había acudido previamente al médico de Atención Primaria

PURPOSE: to assess most common causes requiring hospital emergency care and their seriousness by means of a comparison and analysis of the differences between native population and immigrant population. MATERIAL AND METHODS: a 12-month (July 2011-June 2012), cross sectional, descriptive study was carried out over several working shifts in an emergency department at the Móstoles Hospital, Madrid, Spain. Study endpoints: sex, age, country of origin, MTS (Manchester Triage System), reason for consultation, having a medical card, and previous Primary Care visit. RESULTS: overall, 238 patients were assessed: 190 native patients and 48 immigrant patients. A majority of immigrant patients (54%)were from Latin America. Most common MTS was green (standard category) (51.7%). Statistically significant differences were found forage (younger age in immigrant patients) and reason for consultation(cardiac problems more common in native patients), but not for sex, MTS, or previous visit to a Primary Care doctor. CONCLUSIONS: MTS-based seriousness of conditions resulting in emergency department visits at Móstoles Hospital is similar in immigrant and native patients. Immigrant patients were younger, and cardiac problems were more common in native patients. More than 70% of patients in both groups did not attend to a previous visit to a Primary Care doctor

Series médicas en televisión vistas por estudiantes de medicina / Medical television series seen by students of medicine

Introducción. Después del éxito de la serie televisiva Urgencias, ha proliferado en estos últimos 10 años la producción y emisión de 'series de médicos'. Pretendemos analizar si nuestros estudiantes de medicina ven estas series, por qué les atraen y si les influyen de algún modo. Sujetos y métodos. Se incluyeron todos los alumnos de primer, segundo y tercer cursos del Grado de Medicina en la Universidad Europea de Madrid durante el año académico 2010-2011. Se realizó una encuesta sobre la visualización y percepción de las series de médicos de mayor audiencia en España: Urgencias, Hospital Central, House y Anatomía de Grey. El trabajo de campo se hizo en marzo de 2011. Resultados. Cumplimentaron la encuesta 213 alumnos (53% de la muestra), con una edad media de 19,5 años. El 70,8 % eran mujeres. El 84% veían con frecuencia de una a tres de las series planteadas, siendo la más seguida House (68,1%). Lo que atrae al 70% es tanto el contenido médico como la trama argumental no médica. La credibilidad médica que dan a las series es alta, por encima de 2,5 (en una escala de 1 a 5), siendo Urgencias la más creíble para ellos. Para un 26,8%, el hecho de ver estas series habría podido influir en su elección profesional. Conclusiones. Dado que nuestros alumnos de medicina ven con frecuencia este tipo de series y pueden influirles en algún sentido, nuestro deber como docentes es estimular una visión crítica del contenido médico-científico que en ellas aparece (AU)

Introduction. After the success of television series ER (Emergency Room), over the past 10 years the production and issuance of 'medical series' has proliferated. We intend to analyze if our medical students see this series, why and if they are influenced in some way by seen them. Subjects and methods. We included all students in 1st, 2nd and 3rd Degree in Medicine at the Universidad Europea de Madrid for the 2010-2011 academic year. The survey included a series of questions about viewing and perceptions of the series of doctors with the largest audience in Spain: ER, Hospital Central, House MD and Grey's Anatomy. Fieldwork was conducted in March 2011. Results. 213 students completed the survey (53% of the sample) with a mean age of 19.5 years. 70.8% were women. 84% of students reported having seen frequently from one to three of the series raised, the most followed was House MD (68.1%). 70% of them see this series because medical and non-medical plot. The medical credibility that they give this series is high, above 2.5 (on a scale of 1 to 5), being the most credible ER. 26.8% claimed that the display of these series had been able to influence their career choice. Conclusions. Because our medical students often see this type of series and can influence them in some sense, our duty as teachers is to encourage a critical view of medical and scientific content that appears on them (AU)

Mitos o leyendas urbanas relacionadas con la salud en estudiantes universitarios / Health myths or urban legends of university students

Objetivos: determinar el grado de conocimiento de una serie de mitos relacionados con la salud y el grado de credibilidad que éstos tienen en una población de alumnos universitarios de primer curso de distintas carreras,en la Facultad de Ciencias de la Salud de la Universidad Europea de Madrid. Material y métodos: estudio descriptivo transversal en el curso académico2009-2010 sobre una población de alumnos de primer curso de Grado de Enfermería, Grado de Odontología y Grado de Fisioterapia. Se utilizó un cuestionario estructurado de elaboración propia que conteníapreguntas sobre 10 mitos relacionados con la salud, además de variables sociodemográficas. Se calcularon índices de estadística descriptiva y para el análisis bivariante se utilizó la χ2 , la t de Student y ANOVA.Resultados: participaron 149 alumnos en el estudio (50 de Enfermería,54 de Fisioterapia y 45 de Odontología). Su edad media fue de 19,7 años, siendo el 57% mujeres. En lo relacionado con los mitos planteados manifestaron conocer una media de 7 (DE: 1,7) y consideraban que eran ciertos una media de 4,5 (DE:1,6). La única variable que se asoció con mayor conocimiento de mitos fue el sexo (femenino), mientras que tener más edad y el haber trabajado en el ámbito de la salud se asoció con un mayor porcentaje de mitos en los que creían.Conclusiones: los mitos relacionados con la salud son conocidos porlos futuros sanitarios antes de comenzar sus estudios y la mayoría son considerados como ciertos. Es importante transmitir a los alumnos de Ciencias de la Salud que han de contrastar el fundamento científico de toda aquella información oral que reciban o a través de la red (AU)

Objectives: to determine the level of knowledge held on a series of health-related myths and their degree of credibility in a population composed of first cycle university students from different academic programs,in the school of health sciences of the European University of Madrid. Material and methods: cross-sectional descriptive study during the2009-2010 school year using a population composed of first cycle Nursing, Dentistry and Physical Therapy university students. A self-elaborated structured questionnaire that contained questions on 10 health-relatedmyths and sociodemographic variables was used. Descriptive statistical indexes were calculated and χ2, Student’s t test and ANOVA were utilizedfor the bivariate analysis.Results: 149 students participated in the study (50 from Nursing School,54 from Physical Therapy and 45 from Dentistry). Their mean age was19,7 years, and 57% were women. In regards to the myths presented,the students reported being aware of an average of 7 (SD: 1,7) and considered an average of 4,5 (SD: 1,6) to be true. The only variable associated with a greater knowledge of myths was sex (female), while being older and having worked in the health field were associated with a larger percentage of believed myths.Conclusions: future healthcare professionals are aware of health myths prior to starting their studies and most of these myths are considered to be true. It is important to explain to Health Sciences students that they should contrast the scientific basis of all information received by word of mouth or on the Internet (AU)

Prurito perineal tras la administración intravenosa de hidrocortisona fosfato sódico / Perineal pruritus after intravenous administration of hydrocortisone sodium phosphate

Objetivos: Establecer la frecuencia con la que aparece prurito genital tras administrar hidrocortisona iv y los factores que determinan su aparición. Método: Estudio observacional, prospectivo de pacientes que recibieron hidrocortisona fosfato sódico i.v en el servicio de urgencias del Hospital La Paz entre diciembre de 2007 y mayo de 2008. Se rellenó un protocolo donde se incluyeron las variables: edad, sexo, dosis, forma de administración, aparición de prurito e intensidad del mismo y fármacos concomitantes. Resultados: Se incluyeron 54 pacientes de los cuales 39 eran varones (72,2%). La edad media fue de 56,9 años. Las dosis administradas fueron 200 mg en 30 pacientes (55,6%)y 100 mg en el resto. Presentaron prurito en el área anogenital 26 enfermos (48,1%),que osciló entre 5 y 45 segundos y que cedió espontáneamente. Se encontraron diferencias significativas en relación con la edad (los pacientes con prurito tenían menor edad media) y con la forma de perfusión; de tal forma que cuanto más concentrado y más rápido(en bolo) se administre, mayor es la probabilidad de presentar prurito. Conclusiones: La aparición de prurito tras la administración de hidrocortisona fosfato sódico intravenosa es un hecho frecuente y pasajero que aparece especialmente en personas jóvenes y cuando se administra en bolo. La administración de este fármaco diluido en 50 ml de suero, cuando sea posible, puede evitar la aparición de este efecto secundario (AU)

Objectives: To determine the frequency of genital pruritus after intravenous administration of hydrocortisone and the associated risk factors. Methods: Observational, prospective study of patients who received intravenous hydrocortisone sodium phosphate in the emergency department of La Paz Hospital between December 2007 and May 2008. The variables studied included age, sex, dose, form of administration, onset of pruritus, the severity of itching, and concomitant medication. Results: We included 54 patients, of whom 39 were males (72.5%). The mean age was 56.9 years. The dose administered was 200 mg in 30 patients (55.6%) and 100 mg in the remainder. In total, 26 patients developed anogenital pruritus(48.1%). Itching lasted between 5 and 45 seconds and resolved spontaneously. Significant differences were observed with respect to age (the mean age of the patients with pruritus was lower) and the infusion method used (the higher the concentration used and the faster the drug was administered, the greater the probability of pruritus).Conclusions: Transient pruritus following administration of intravenous hydrocortisone sodium phosphate is a commonside effect that affects younger people and is associated with bolus administration. Dilution of the drug in 50 mL of saline solution, whenever possible, can prevent the appearance of this side effect (AU)