Tumor neuroendocrino apendicular pediátrico: análisis de una serie / Pediatric neuroendocrine appendicular tumor: a case-series analysis

INTRODUCCIÓN: El tumor neuroendocrino es la neoplasia apendicular más frecuente en la edad pediátrica. Existen guías sobre su manejo en adultos pero no se han elaborado guías para pacientes pediátricos, lo que conlleva un manejo muy heterogéneo en este grupo de edad. Se presenta una serie de casos con el objetivo de mejorar el conocimiento de estos tumores. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de los casos de tumor neuroendocrino apendicular hallados en piezas de apendicectomía entre enero de 2004 y diciembre de 2017 en dos hospitales terciarios, en menores de 18 años. RESULTADOS: se incluyeron 6 pacientes, 4 varones y 2 mujeres. En todos el síntoma principal fue el dolor abdominal, ninguno presentó síndrome carcinoide. En uno de ellos el tumor se localizó en base y tuvo dudosa afectación de márgenes, por lo que se realizó una segunda cirugía. En el resto, la apendicectomía fue curativa. Sólo en 3 se hizo seguimiento. CONCLUSIONES: según la mayoría de autores no es necesaria una segunda cirugía tras el diagnóstico, ni tampoco el seguimiento pues se han encontrado supervivencias similares cuando se comparan grupos. Esta afirmación parece aún más clara en tumores <1 cm y sin factores de riesgo asociados, sobre todo la invasión del mesoapéndice. En cualquier caso, hacen falta estudios para la elaboración de guías que permitan homogeneizar su manejo en la edad pediátrica

INTRODUCTION: The neuroendocrine tumor is the most frequent appendix neoplasia in the pediatric age. Although multiple guides about the management of this tumor in adults exist, no guides with focus on children have been created. That makes the management of the tumor for this population very heterogeneous. Several cases are presented below with the objective to improve the knowledge on this area. MATERIAL AND METHODS: a retrospective study of the appendix neuroendocrine tumor found in appendectomy pieces on patients under eighteen was carried out in two tertiary hospitals - Nuestra Señora del Prado in Talavera de la Reina and Virgen de la Salud in Toledo- between January 2004 and December 2017. RESULTS: six patients were under study, 4 men and 2 women. In all of them, the main symptom was abdominal pain, any of them showed carcinoid syndrome. One had a tumor located in the base. In this case a second surgery was necessary due to the suspicion of affected margins. Regarding the rest of the patients, the appendectomy was curative. Only in three of them a follow up was done. CONCLUSIONS: According to the majority of the authors, neither a second surgery nor a follow up is necessary after the diagnosis, having similar results when comparing groups. This statement becomes more significant in tumors <1 cm and without associated risk factors, specially the deep masoappendiceal infiltration. In any case, it is clear that further studies must be conducted in order to elaborate guides that allow making the management of the tumor more homogeneous

Cognitive functions of subjects with cocaine and crack dependency disorder during early abstinence. / Funcionamiento cognitivo en sujetos con trastorno de dependencia a cocaina y crack durante la abstinencia temprana.

INTRODUCTION: Cognitive effects caused by cocaine and crack consumption, especially deficits in executive functions may increase the likelihood of drug-seeking behaviour and interfere with the ability of users to assimilate and participate in rehabilitation programs. AIM: To determine in early abstinence the state of executive functions, the impulsiveness and craving in cocaine and crack consumers. SUBJECTS AND METHODS: This cross-sectional study functions, with a sample of 60 male aged between 31.38 ± 7.26 years old, distributed in three groups: inhaled cocaine users (CDP-I; n = 15), with 23.13 ± 7.2 age of onset of consumption; crack cocaine users (CDP-C; n = 26), with 20.81 ± 4.21 age of onset of consumption, and a control groups of no-addiction individuals (n = 19). Sociodemographic, clinical and cognitive assessments were applied. RESULTS: The data showed that significant differences in socioeconomic level score and impulsiveness. Consumer groups have with lower scores with respect the control group. CDP-C group showed poor performances compared to the CDP-I and control groups, in the Berg Test, Tower of London, numbers in the direct order and subtraction. CDP-I group showed less score in planning compare with the other two groups. CONCLUSIONS: In early abstinence crack users manifest a greater number of deficits, mainly in working memory, planning and cognitive flexibility.

TITLE: Funcionamiento cognitivo en sujetos con trastorno de dependencia a cocaina y crack durante la abstinencia temprana.Introduccion. Los efectos cognitivos causados por el consumo de cocaina y crack, especialmente los deficits de las funciones ejecutivas, aumentan la probabilidad de un comportamiento de busqueda de drogas e interfieren en la capacidad de los usuarios de asimilar y participar en los programas de rehabilitacion. Objetivo. Determinar en la abstinencia temprana el estado de las funciones ejecutivas, la impulsividad y la ansiedad (craving) en consumidores de cocaina y crack. Sujetos y metodos. Este estudio transversal tuvo una muestra de 60 hombres, con una edad media de 31,38 ± 7,26 años, distribuidos en tres grupos: usuarios que inhalan cocaina (CDP-I; n = 15), con una edad de inicio de consumo de 23,13 ± 7,2 años; consumidores de cocaina en crack (CDP-C; n = 26), con una edad de inicio de consumo de 20,81 ± 4,21 años, y un grupo control de sujetos sin adiccion (n = 19). Se aplicaron evaluaciones sociodemograficas, clinicas y cognitivas. Resultados. Los datos mostraron diferencias significativas en las puntuaciones del nivel socioeconomico e impulsividad. Los grupos de consumidores tienen puntuaciones mas bajas con respecto al grupo control. El grupo CDP-C mostro rendimientos pobres en comparacion con el grupo CDP-I y el grupo control en las pruebas de Berg, torre de Londres, numeros en orden y sustraccion directos. El grupo CDP-I mostro una menor puntuacion en la planificacion comparada con los otros dos grupos. Conclusiones. En la abstinencia temprana, los consumidores de crack manifiestan mayor numero de deficits, principalmente en la memoria de trabajo, la planificacion y la flexibilidad cognitiva.

Comparison of clinical and cognitive characteristics of a Mexican adult clinical population with and without ADHD / Comparación de las características clínicas y cognitivas de una población clínica adulta mexicana con y sin TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of the world population, with symptoms that may persist into adulthood. Despite the findings on the clinical course of this disorder, information regarding comorbidity patterns, psychosocial and executive functioning in adult life in those with and without ADHD in Latin American samples is scarce. Objective The aim of this study is to compare the comorbidity pattern, psychosocial, and executive functioning of adults with and without ADHD from a clinical sample. Method One hundred and fifty-one patients between 20 and 45 years, with screened positively on ASRS-V1.1, were invited to continue an evaluation process as part of clinical research program (PROMETEO): 1) K-SADS-PL Mx interview, 2) MINI-Plus interview, ASRS-V1-1 18 item version, BRIEF self-reported questionnaire, SCQA-ADHD, and 3) Individual case review by clinical expert in ADHD. Results Individuals in the ADHD group had a higher average of comorbid disorders (2.5 SD 1.1 vs. 1.3 SD 1.0 respectively, F = .439; t = -6.621; df = 149; p < .001), more likelihood of procrastinating (OR = 6.5; 95% CI[2.6, 16.2]; z = 4.0) and were more likely to present difficulties in both the behavior regulation index (OR = 104.9; 95% CI[31.8, 345.7]; z = 7.65) and the metacognitive index (OR = 94.79; 95% CI[29.10, 308.76]; z = 7.56) compared to the non-ADHD group, regardless of gender. Discussion and conclusions Our results indicate that the ADHD adult group presented with more comorbidity, and worse psychosocial and executive functioning than non-ADHD adults.

Resumen Introducción El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo que afecta aproximadamente al 5% de la población mundial, persistiendo hasta la adultez. A pesar de los hallazgos acerca del curso clínico de este trastorno, la información es escasa con respecto a los patrones de comorbilidad, funcionamiento psicosocial y ejecutivo en la vida adulta entre aquellos con y sin TDAH en muestras latinoamericanas. Objetivo Comparar el patrón de comorbilidad, el funcionamiento psicosocial y ejecutivo de adultos con y sin TDAH de una muestra clínica. Método Ciento cincuenta y un pacientes entre 20 y 45 años, quienes inicialmente presentaron un tamizaje positivo del ASRS-V1.1, fueron evaluados dentro de un programa de investigación clínica (PROMETEO) con los siguientes instrumentos: 1) la entrevista K-SADS-PL-Mx, 2) la entrevista MINI-Plus, la version de 18 items del ASRS-V1-1, y los cuestionarios autoaplicados BRIEF y SCQA-ADHD y 3) Revisión de cada caso por un clínico experto en el diagnóstico de TDAH. Resultados El grupo de TDAH comparado con aquel sin TDAH presentó un mayor promedio de trastornos comórbidos (2.5 DE 1.1 vs 1.3 DE 1.0 respectivamente, F = .439; t = -6.621; gl = 149; p < .001), mayor probabilidad de procrastinar (OR = 6.5; 95% IC[2.6, 16.2]; z = 4.0), y mayor probabilidad de presentar dificultades tanto en el índice de regulación de la conducta (OR = 104.9; 95% IC[31.8, 345.7]; z = 7.65) como en el índice metacognitivo (OR = 94.79; 95% IC[29.10, 308.76]; z = 7.56) independientemente del sexo. Discusión y conclusión Nuestros resultados señalan que los adultos con TDAH presentan mayor comorbilidad y peor funcionamiento psicosocial y ejecutivo que los adultos sin TDAH.

The effect of crack cocaine addiction and age on the microstructure and morphology of the human striatum and thalamus using shape analysis and fast diffusion kurtosis imaging.

The striatum and thalamus are subcortical structures intimately involved in addiction. The morphology and microstructure of these have been studied in murine models of cocaine addiction (CA), showing an effect of drug use, but also chronological age in morphology. Human studies using non-invasive magnetic resonance imaging (MRI) have shown inconsistencies in volume changes, and have also shown an age effect. In this exploratory study, we used MRI-based volumetric and novel shape analysis, as well as a novel fast diffusion kurtosis imaging sequence to study the morphology and microstructure of striatum and thalamus in crack CA compared to matched healthy controls (HCs), while investigating the effect of age and years of cocaine consumption. We did not find significant differences in volume and mean kurtosis (MKT) between groups. However, we found significant contraction of nucleus accumbens in CA compared to HCs. We also found significant age-related changes in volume and MKT of CA in striatum and thalamus that are different to those seen in normal aging. Interestingly, we found different effects and contributions of age and years of consumption in volume, displacement and MKT changes, suggesting that each measure provides different but complementing information about morphological brain changes, and that not all changes are related to the toxicity or the addiction to the drug. Our findings suggest that the use of finer methods and sequences provides complementing information about morphological and microstructural changes in CA, and that brain alterations in CA are related cocaine use and age differently.

Fe de errores de «Prevalencia del dolor neuropático (DN), según DN4, en atención primaria» / Erratum to: ‘‘Prevalence of Neuropathic Pain according to the NP4 test in Primary Care’’

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Prevalencia del dolor neuropático (DN), según DN4, en atención primaria / Prevalence of Neuropathic Pain according to the NP4 test in Primary Care

Introducción. El médico de atención primaria suele ser el primero en atender a pacientes con dolor neuropático. Se pretende evaluar la prevalencia del dolor neuropático, su manejo terapéutico y la caracterización clínica de estos pacientes. Material y métodos. Estudio epidemiológico, observacional y transversal realizado en centros de atención primaria de España. Registro de los primeros 25 pacientes ≥ 18 años con dolor de cualquier tipo (total 16.115) e inclusión de los 5 primeros con alto componente neuropático identificados mediante DN4 y confirmados clínicamente (3.836 evaluables). Se valoró la intensidad e impacto del dolor sobre las actividades diarias y la satisfacción con el tratamiento. Resultados. El 45,7% de los pacientes presentaron dolor neuropático según DN4. La edad media era 59 años y un 60% eran mujeres. Los pacientes utilizaban una media global de 2,4 fármacos los 3 meses previos al estudio, principalmente antiinflamatorios no esteroideos (AINE) (53%) y analgésicos no opioides (51%). Las puntuaciones de la intensidad del dolor e interferencia sobre las actividades diarias fueron ambas 6,2. La opinión general del SATMED-Q fue 47,3/100 que está 1,4 puntos por debajo de la obtenida por la población general española. Conclusiones. El dolor neuropático, según cuestionario DN4, es muy prevalente en los centros de atención primaria españoles. El manejo de estos pacientes con AINE y analgésicos no opioides no es adecuado, ya que no están recomendados para este tipo de dolor, y aun siendo tratados con más de 2 fármacos, los pacientes continúan presentando un dolor moderado con interferencia sobre sus actividades (AU)

Background. Primary Care Physicians are usually the first to see patients with neuropathic pain. The aim of this study is to assess the prevalence of neuropathic pain, its therapeutic management, and to clinically characterize these patients. Material and methods. An epidemiological, observational, cross-sectional study was carried out in Spanish Primary Care settings. The first 25 patients older than 18 years with any type of pain (a total of 16,115) were registered, and the first 5 with a high neuropathic pain component according to the NP4 test, and was clinically confirmed (n= 3,836) were included in the study. Pain intensity and impact on daily activities, as well as overall satisfaction with treatment were assessed. Results. A total of 45.7% of patients had neuropathic pain according to NP4 test. The median age was 59 years, and 60% were women. Patients took a mean of 2.4 drugs, with NSAIDs (53%) and non-opioid analgesics (51%) being the most common. The scores for Pain intensity and interference in daily activities were both 6.2. The overall opinion of the SATMED-Q test was 47.3/100, which was 1.4 points lower than the standardised score according to Spanish population. Conclusions. Neuropathic pain according to NP4 test is highly prevalent in Spanish Primary Care settings. The management of these patients with NSAIDs and non-opioid analgesics is not appropriate, as they are not recommended for this kind of pain. Although they were being treated with more than 2 analgesics, they still referred to high pain intensity, interference in daily activities, and a low general opinion of the treatment (AU)

[Prevalence of neuropathic pain according to the NP4 test in primary care]. / Prevalencia del dolor neuropático (DN), según DN4, en atención primaria.

BACKGROUND: Primary Care Physicians are usually the first to see patients with neuropathic pain. The aim of this study is to assess the prevalence of neuropathic pain, its therapeutic management, and to clinically characterize these patients. MATERIAL AND METHODS: An epidemiological, observational, cross-sectional study was carried out in Spanish Primary Care settings. The first 25 patients older than 18 years with any type of pain (a total of 16,115) were registered, and the first 5 with a high neuropathic pain component according to the NP4 test, and was clinically confirmed (n= 3,836) were included in the study. Pain intensity and impact on daily activities, as well as overall satisfaction with treatment were assessed. RESULTS: A total of 45.7% of patients had neuropathic pain according to NP4 test. The median age was 59 years, and 60% were women. Patients took a mean of 2.4 drugs, with NSAIDs (53%) and non-opioid analgesics (51%) being the most common. The scores for Pain intensity and interference in daily activities were both 6.2. The overall opinion of the SATMED-Q test was 47.3/100, which was 1.4 points lower than the standardised score according to Spanish population. CONCLUSIONS: Neuropathic pain according to NP4 test is highly prevalent in Spanish Primary Care settings. The management of these patients with NSAIDs and non-opioid analgesics is not appropriate, as they are not recommended for this kind of pain. Although they were being treated with more than 2 analgesics, they still referred to high pain intensity, interference in daily activities, and a low general opinion of the treatment.

Spanish version of the Northwick Park Neck Pain Questionnaire: reliability and validity.

OBJECTIVE: To validate a Spanish version of the Northwick Park Neck Pain Questionnaire (NPQ) and to prove its usefulness in clinical practice. METHODS: We studied 58 patients with non-inflammatory neck pain of more than 4 months duration. A blind back translation of the NPQ was made, and the resulting back-translation version was then compared with the original. The NPQ comprises 9 questions with 5 statements of increasing difficulty. Patients completed the questionnaire 3 times: on their initial assessment; 8-10 days later (test-retest); and after physiotherapy treatment 3 months later. Neck pain was assessed by a visual analogue scale (VAS). RESULTS: Fifty-three patients completed the questionnaire (90%). There was a good intra-class correlation between the test-retest NPQ (r = 0.63), indicating good agreement. For each of the 9 sections, agreement ranged from r = 0.43 to r = 0.85, p < 0.05 in all cases. Correlation with the VAS was also good, between r = 0.51 (test) and r = 0.74 (retest) (p < 0.05 in all cases). Pain measured by the VAS increased according to the NPQ score, grouped by percentages (p = 0.003). The mean scores for each section increased with that of the intensity of pain, in most sections showing good internal consistency. Pain and the NPQ score improved after treatment (56.1 +/- 20.2 to 29.9 +/- 20.1, p = 0.0001 and 45.9% +/- 12.7% to 28.9% +/- 15.3%, p = 0.0001 respectively), as did all the other items except for driving (p < 0.05). CONCLUSIONS: The Spanish version of the NPQ is a feasible, reliable and valid instrument to measure pain in Spanish-speaking patients with chronic neck pain.

Eficacia terapéutica del Nimesulide en el tratamiento de la dorso lumbalgia de origen traumático / Therapeutic effectiveness of the nimesulide in the treatment of the low back pain of traumatic origin

Se realizó un estudio abierto, no controlado, multicéntrico, realizado con intención de tratar, en 60 pacientes con dorsolumbalgia mecánica, en el cual evaluó la efectividad y seguridad de nimesulide 100 mg dos veces al día, administrado durante 15 días. El tratamiento produjo un alivio significativo en los escores de dolor entre el día de inicio del tratamiento y los 5 días, con un alivio adicional importante entre los días 5 y 10, sin alivios adicionales para el día 15. El tiempo medio para la desaparición total del dolor fue de 8,5 días. La limitación funcional fue evaluada el día 0 y el día 15, obteniéndose una mejoría significativa desde el punto de vista estadístico. Se reportaron efectos adversos en 4 de los pacientes, de los cuales sólo uno ameritó la suspensión del tratamiento