Lesión medular asociada a hematoma epidural espinal espontáneo / Spinal cord injury associated with spontaneous spinal epidural hematoma

Introducción: El hematoma epidural espinal espontáneo (HEEE) es una entidad de baja incidencia, de elevada morbimortalidad y que causa una importante limitación funcional en la vida de los pacientes. Material y métodos: Con el objetivo de determinar la incidencia del HEEE y el tipo de lesión medular provocada y su repercusión funcional en este centro hospitalario, se realizó un estudio descriptivo retrospectivo analizando variables demográficas, de la lesión (ISCNSCI) y de la funcionalidad (SCIMIII). Resultados: Se revisaron los casos de HEEE atendidos en este centro. El 75% eran varones, con una mediana de edad de 55años. Todas las lesiones fueron incompletas. La localización más frecuente de las lesiones fue a nivel cervical bajo y dorsal alto. La mitad de los sangrados se produjeron en la región medular anterior. Se objetivó mejoría funcional tras el programa específico de rehabilitación. Conclusión: El HEEE podría considerarse de buen pronóstico funcional, relacionado con lesiones medulares habitualmente posteriores e incompletas sensitivo-motoras que se beneficiarían de un tratamiento rehabilitador específico precoz.(AU)

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methods: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). Results: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. Conclusion: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.(AU)

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Productividad laboral en pacientes con artritis reumatoide temprana / Work productivity in patients with early rheumatoid arthritis

Introducción: La artritis reumatoide tiene un importante impacto sobre la función física y la productividad laboral. Objetivo: Determinar la productividad laboral de los pacientes con artritis reumatoide temprana identificando su relación con variables sociodemográficas y clínicas. Método: Se realizó un estudio observacional descriptivo de corte transversal en 53 pacientes atendidos en el Centro de Referencia de Enfermedades Reumáticas entre enero a diciembre de 2019. Para evaluar la productividad laboral se utilizó el cuestionario WPAI-AR. Resultados: Predominaron los pacientes entre los 35-55 años de edad (60,4 por ciento), el sexo femenino (60,4 por ciento). La productividad laboral medida a través de WPAI-AR reportó durante los últimos 7 días una media de 4,64 horas laborales perdidas, secundaria a la artritis reumatoide, con un porciento de pérdida por ausentismo del 16,5 por ciento y presentismo del 59,6 por ciento. Conclusiones: El mayor porciento de afectación de la productividad laboral le correspondió al presentismo. Se encontró asociación entre la pérdida de productividad laboral y la actividad clínica, la discapacidad funcional y la calidad de vida relacionada con la salud(AU)

Introduction: rheumatoid arthritis has been reported to have a significant impact on physical function and work productivity. Objectives: To determine the labor productivity of patient's diagnosis with early rheumatoid arthritis and to identify its possible relationship with sociodemographic and clinical variables. Methods: A cross-sectional descriptive observational study was carried out in 53 patients treated at the Reference Center for Rheumatic Diseases between January to December 2019. To evaluate labor productivity, the WPAIR AR questionnaire was used. Results: patients between 35-55 years of age predominated 60.4 percent, the female sex 60.4 percent. Labor productivity measured by WPAI AR reported during the last 7 days an average of 4.64 working hours lost, secondary to early rheumatoid arthritis, with a percentage of loss due to absenteeism of 16.5 percent and presenteeism of 59.6 percent. Conclusion: Conclusion: the highest percentage of affectation of labor productivity corresponded to labor presenteeism. Loss of work productivity was significantly associated with clinical activity, functional capacity, and health-related quality of lifepor ciento(AU)

Transcultural adaptation and validation of the Spanish-language version of ACTIVLIM in adults with inherited myopathies using the Rasch model.

INTRODUCTION: ACTIVLIM is an instrument for the measurement of activity limitations in patients with neuromuscular disorders. The aim of this study is to establish a transcultural adaptation and psychometric validation of the Spanish-language version of ACTIVLIM in a sample of Spanish patients with inherited myopathies. PATIENTS AND METHOD: A Spanish-language version of ACTIVLIM was developed using the translation/back translation method. The questionnaire was administered to 135 patients with inherited myopathies. The psychometric properties of the questionnaire were assessed using the Rasch model. Floor and ceiling effects were estimated. Unidimensionality was evaluated with a principal component analysis of the residuals of the model, and using infit and outfit statistics. We estimated reliability with the person separation reliability index and invariance with differential item functioning. External construct validity was tested through correlation with the Brooke scale, the Vignos scale, the Functional Independence Measure scale, and floor-to-stand time. Test-retest reliability was evaluated with the intraclass correlation coefficient and differential item functioning. RESULTS: The psychometric analysis of the Spanish-language version of ACTIVLIM demonstrated that floor effect was absent, although a modest ceiling effect was identified. The instrument displayed unidimensionality, good internal consistency, external construct validity, and good test-retest reliability. CONCLUSION: The Spanish-language version of ACTIVLIM is a valid and reliable measurement instrument for assessing activity limitations in patients with inherited myopathies.

ACTIVLIM: adaptación transcultural al castellano y validación en adultos con miopatías hereditarias utilizando el modelo Rasch / Transcultural adaptation and validation of the Spanish-language version of ACTIVLIM in adults with inherited myopathies using the Rasch model

Introducción: ACTIVLIM es un instrumento de medición de la limitación funcional en pacientes con enfermedades neuromusculares. El objetivo de este estudio es la adaptación transcultural y la validación psicométrica de la versión en castellano del ACTIVLIM en una muestra española de pacientes con miopatías hereditarias.Pacientes y métodoSe elaboró una versión en castellano del cuestionario ACTIVLM mediante el método de traducción-retrotraducción. El cuestionario obtenido fue cumplimentado por 135 pacientes con miopatías hereditarias. Las propiedades psicométricas del mismo fueron evaluadas mediante el modelo Rasch. Se valoró la adecuación del rango mediante la estimación de efectos techo y suelo; la unidimensionalidad mediante análisis de componentes principales de los residuales del modelo y estadísticos infit y outfit; la fiabilidad mediante el índice de fiabilidad asociado al índice de separación y la invarianza mediante la estimación del funcionamiento diferencial. Asimismo, la validez de constructo se evaluó estimando la correlación con las escalas de Brooke, de Vignos, la medida de independencia funcional y el tiempo de Gowers, y la fiabilidad test-retest mediante el índice de correlación intraclase y con el plot del funcionamiento diferencial del ítem.ResultadosEl análisis psicométrico de la versión en castellano del ACTIVLIM demostró ausencia de efecto suelo y moderado efecto techo, unidimensionalidad, una buena consistencia interna, validez externa de constructo y buena fiabilidad test-retest.ConclusiónLa versión en castellano del ACTIVLIM es un instrumento de medición válido y fiable para evaluar las limitaciones en la actividad en pacientes con miopatías hereditarias. (AU)

Introduction: ACTIVLIM is an instrument for the measurement of activity limitations in patients with neuromuscular disorders. The aim of this study is to establish a transcultural adaptation and psychometric validation of the Spanish-language version of ACTIVLIM in a sample of Spanish patients with inherited myopathies.Patients and methodA Spanish-language version of ACTIVLIM was developed using the translation/back translation method. The questionnaire was administered to 135 patients with inherited myopathies. The psychometric properties of the questionnaire were assessed using the Rasch model. Floor and ceiling effects were estimated. Unidimensionality was evaluated with a principal component analysis of the residuals of the model, and using infit and outfit statistics. We estimated reliability with the person separation reliability index and invariance with differential item functioning. External construct validity was tested through correlation with the Brooke scale, the Vignos scale, the Functional Independence Measure scale, and floor-to-stand time. Test-retest reliability was evaluated with the intraclass correlation coefficient and differential item functioning.ResultsThe psychometric analysis of the Spanish-language version of ACTIVLIM demonstrated that floor effect was absent, although a modest ceiling effect was identified. The instrument displayed unidimensionality, good internal consistency, external construct validity, and good test-retest reliability.ConclusionThe Spanish-language version of ACTIVLIM is a valid and reliable measurement nstrument for assessing activity limitations in patients with inherited myopathies. (AU)

Paniculectomía masiva, cirugía funcional para pacientes con panniculus morbidus / Massive panniculectomy, a functional surgery for patients with panniculus morbidus

Panniculus morbidus es una enfermedad asociada a la obesidad mórbida que genera problemas higiénicos y discapacidad funcional. La paniculectomía masiva conlleva varias complicaciones, sin embargo, permite restaurar la calidad de vida y funcionalidad del paciente convirtiéndose así en un reto para el cirujano en su planificación, ejecución y manejo peri operatorio y más aún si no se tienen los medios. Es por ello que esta serie de casos tiene como objetivo presentar nuestra experiencia quirúrgica en el manejo de pacientes con obesidad mórbida sometidos a paniculectomía funcional con resultados satisfactorios. Desde nuestra experiencia en el abordaje de estos pacientes destacamos que la ausencia de materiales de suspensión no imposibilita llevar a cabo la cirugía con resultados aceptables siempre y cuando se tomen en cuenta los conceptos de resección y síntesis de la pared abdominal.(AU)

Panniculus morbidus is a disease associated with morbid obesity that generates hygienic problems and functional disability. Massive panniculectomy involves several complications, however, it allows restoring the patient's quality of life and functionality, thus becoming a challenge for the surgeon in his planning, execution and perioperative management and even more if the materials are not available. That is why this case series aims to present our surgical experience in the management of morbidly obese patients undergoing functional panniculectomy with satisfactory results. From our experience in the approach of these patients, we highlight that the absence of suspension materials does not make it impossible to carry out the surgery with acceptable results as long as the concepts of resection and synthesis of the abdominal wall were taken into account.(AU)

Relação familiar da pessoa idosa com comprometimento da capacidade funcional / Relación familiar del adulto mayor con comprometimiento de la capacidad funcional / Family Relationships of Elderly Adults with Compromised Functional Capacity

Objetivo: compreender a relação familiar da pessoa idosa com comprometimento da capacidade funcional. Materiais e métodos: estudo exploratório e descritivo de abordagem qualitativa, fundamentado no método da história oral, realizado com 15 pessoas idosas assistidas por uma unidade de saúde da família, residentes com familiares e que apresentavam comprometimento da capacidade funcional. Os dados foram coletados no período de março a abril de 2012, por meio de entrevistas em profundidade. As categorias temáticas foram: bom relacionamento familiar, mudanças na relação familiar, sentindo-se um incômodo para a família, sentindo-se abandonado pela família. Resultado: o estudo revelou que as pessoas idosas com comprometimento da capacidade funcional vivenciam sentimentos variados, que vão desde a alegria, por serem respeitadas e terem suas necessidades atendidas, à tristeza e revolta, pela adaptação negativa da família e o abandono dos filhos. Conclusão: a relação familiar da pessoa idosa passa por reajustes após o comprometimento da capacidade funcional, o que repercute significativamente na dinâmica das relações. A partir dessa compreensão, os profissionais de saúde, sobretudo de enfermagem, devem reconhecer os desafios enfrentados pela família, orientá-la e capacitá-la para o atendimento às demandas de cuidado apresentadas pela pessoa idosa com comprometimento da capacidade funcional, e favorecer a realização do cuidado sem que haja desgaste das relações.

Objetivo: comprender la relación familiar de la persona adulta con comprometimiento de la capacidad funcional. Materiales y métodos: estudio exploratorio y descriptivo de abordaje cualitativo, fundamentado en el método de la historia oral, realizado con 15 adultos mayores asistidos por una unidad de salud de la familia, residentes con familiares y que presentaban comprometimiento de la capacidad funcional. Se recolectaron los datos en el período de marzo y abril del 2012, por medio de entrevistas en profundidad. Las categorías temáticas fueron: buena relación familiar, cambios en la relación familiar, sintiéndose un estorbo para la familia, sintiéndose abandonado por la familia. Resultado: el estudio ha revelado que las personas mayores con comprometimiento de la capacidad funcional vivencian sentimientos diversos que van desde la alegría porque son respetadas y tienen sus necesidades atendidas, hasta la tristeza y revuelta, por la adaptación negativa de la familia y el abandono de los hijos. Conclusión: la relación familiar de la persona mayor pasa por reajustes luego del comprometimiento de la capacidad funcional, lo que repercute significativamente en la dinámica de las relaciones. Desde esta comprensión, los profesionales de salud, sobre todo de enfermería, deben reconocer los retos a los que la familia afronta, orientarla y capacitarla para la atención a las demandas de cuidado presentadas por la persona mayor con comprometimiento de la capacidad funcional, y favorecer la realización del cuidado sin que esto desgaste las relaciones.

Objective: This research was intended to understand the family relationships of adults with compromised functional capacity. Materials and Methods: It is an exploratory, descriptive study with a qualitative approach, based on the oral history method. The sample included 15 elderly adults who were being assisted by a family health unit, were living with family members, and had compromised functional capacity. The data were collected between March and April 2012, through in-depth interviews. The subject categories were: good family relationships, changes in family relationships, feeling of being a nuisance to the family, and feeling abandoned or neglected by the family. Result: The study found that elderly adults with compromised functional capacity experience a variety of feelings that range from joy, because they are respected and their needs are met, to sadness and shock over their family's negative adjustment to the situation and by being abandoned or neglected by their children. Conclusion: The dynamics of the family relationships of elderly adults change significantly when the person's functional capacity is compromised. With this in mind, health professionals, especially nurses, must recognize the challenges the family faces and be prepared to guide and train family members to satisfy the demands of caring for an elderly relative with compromised functional capacity and to favor rendering the care that is needed without jeopardizing family relationships.