Síndrome neuroléptico maligno like

RESUMEN El síndrome neuroléptico maligno like o crisis acinética es una rara y potencialmente letal complicación del abandono de medicación de los pacientes con enfermedad de Parkinson. Se presenta el caso clínico de un paciente de sexo masculino de 52 años de edad, con antecedente de enfermedad de Parkinson de 10 años de evolución que se encuentra en tratamiento con levodopa-carbidopa. Acude a consultar por disminución del estado de conciencia y rigidez muscular generalizada, relacionado con el abandono de medicación 7 días antes del inicio de los síntomas.

ABSTRACT Neuroleptic malignant-like syndrome or akinetic crisis is a rare and potentially lethal complication of the withdrawal of medication of patients with Parkinson's disease. We present the clinical case of 52-year man with 10-year history of Parkinson's disease who is being treated with levodopa-carbidopa. He consults for decreased level of consciousness and general muscular rigidity, related to the withdrawal of the medication 7 days before the onset of symptoms.

Intraoperative stress and anxiety reduction with music therapy: a controlled randomized clinical trial of efficacy and safety.

OBJECTIVE: The purpose of this study was to investigate the music therapy (MT) effect in levels of intraoperative anxiety in patients undergoing crossectomy with stripping of the great saphenous vein and to assess the efficacy, safety, and feasibility of this alternative therapy as a complement of standard intraoperative care. MATERIAL AND METHODS: The study is a simple blind, controlled, parallel groups, prospective randomized clinical trial. Patients were allocated by means of randomized controlled sampling. The study was performed in the surgery room of Getafe University Hospital in Madrid. The study was carried out in 40 patients, 20 randomized to the experimental group and 20 randomized to the control group, with an age range from 27 to 70 years. The control group was given intraoperative routine attention, and the experimental group was given an MT passive intervention that consisted of audition of musical fragments during varicose veins surgery. These pieces previously showed relaxing actions on the cardiovascular system. The anxiety levels were measured by means of pre- and postsurgical questionnaires by a blinded investigator for the study arm to which the patients had been randomized. Heart rate and systolic and diastolic blood pressures were determined during the intervention, and adrenaline and noradrenaline plasma levels were determined before and after the surgical procedure. RESULTS: The majority of the patients in the MT group (95%) and standard care group (90%) completed the study. There were no statistical differences between the control and experimental groups in heart rate gradient or systolic and diastolic blood pressures measured after the intervention. The anxiety state and the stress feeling scale score after surgery were significantly inferior in the MT group (94.7% vs 57.9% decrease in anxiety levels, P < .05, and stress score of 1.31 vs 2.36, P < .05, respectively). The adverse events ratio was low and occurred with similar frequency in both groups. CONCLUSIONS: The MT intervention was easily implemented in the context of nursing care received during varicose vein surgery and was positively accepted and valued by the majority of the patients. MT is a safe procedure that is proved to reduce anxiety and stress in the study patients.

Conocimientos y actitudes del personal de enfermería sobre la violencia de género / Knowledge and nurses' attitudes about gender violence

Objetivo: Identificar los conocimientos y las actitudes sobre la violencia de género (VG), así como las barreras personales e institucionales existentes en el personal de enfermería del Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" (INPerIER), con el fin de identificar necesidades de capacitación del personal. Material y métodos: Es un estudio transversal, observacional y analítico. La población seleccionada fueron enfermeras que estuvieron en contacto con mujeres que acudieron a una institución de salud reproductiva de tercer nivel de atención. La recolección de la información fue voluntaria, informada y anónima, a través de la "Encuesta de Violencia contra la Mujer por parte de su pareja: Opinión del Personal de Salud". Para el análisis estadístico, se utilizó un modelo de regresión logística para evaluar el conocimiento sobre normas, guías e instituciones de referencia a los casos de VG y actitudes. Resultados: Participaron 136 enfermeras (tasa de no-aceptación de 9.4%). El promedio de edad fue 37 años, no tenía pareja 52.9% de las encuestadas, la proporción de enfermeras generales fue 51.5%, tenían estudios carrera técnica postsecundaria 47.1% y laboraban en el turno matutino 54.4%. El conocimiento sobre la VG del personal fue 92.6% nulo a bajo y 7.4% medio. Los factores asociados con la actitud cognitiva y conductual de rechazo con la VG fueron: tener edad de 23 a 35 años (RM 2.93 IC 95% 3.0-8.0), familiares con violencia (RM 2.47 IC 95% 1.13-5.37) y nivel de bachillerato (RM 5.03 IC 95% 1.20-10.21). El ser autora de violencia tiene una actitud afectiva desfavorable hacia la VG (OR 5.30 IC 95% 11.08-25.88). Las barreras institucionales y personales para la identificación de los casos de VG, fueron 74.3%. Conclusiones: Se requiere sensibilizar y capacitar para identificar y referir a los casos con VG, además de implementar programas de salud mental para las enfermeras que sean autoras o víctimas de violencia.

Objective: To identify attitudes and knowledge among nurses from Instituto Nacional de Peinatologia (INPerIER) regarding Gender Violence (GV). Material and methods: This is a cross-section, observational and analytic study. Participants were nurses who had been in contact with women attending INPerIER. Information was collected anonymously and voluntary through the "Partner violence against women: healthcare professional's opinion Survey". A logistic regression model was calculated to evaluate the association among several factors including knowledge of guidelines, counselling and centers for assistance to affected women. Results: A total of 136 nurses participated in the study (9.4% non-participants). Average age was 37 years, 52.9% did not have a partner, 51.5% were non-specialized nurses, 47.1% had a post-high school education and 54.4% had an afternoon shift. Knowledge regarding was none-low in 92.6% of the nurses and moderate in 7.4%. Factors associated with cognitive and behavioural attitude and GV included age between 23-35 years (OR 2.93; IC 95%: 3.0-8.0), family members with violence (OR 2.47; IC 95%: 1.13-5.37) and bachelor's level (OR 5.03; IC 95%: 1.20-10.21). The being violence author has an unfavourable affective attitude (OR 5.30; IC 95%: 11.08-25.88). Personal and institutional barriers to identify GV cases were present in 74.3% of the cases. Conclusions: It is necessary to sensitize and train nurses to give assistance or counselling to GV cases, as well as to implement mental health programs for nurses who act violent or are victims of violence.