Residentes de familia en estado de alarma / General practitioners residents at emergency state

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Reducción de masa libre de grasa en nadadores después de un periodo de entrenamiento / Reduction of Fat-Free Mass in Swimmers after Training Period

En los deportistas la masa libre de grasa (MLG) es una característica física que se busca incrementar para aumentar el rendimiento deportivo. El objetivo de este estudio fue determinar si la reducción de la MLG, expresada como índice AKS, se asocia a alteraciones fisiológicas después de un periodo de entrenamiento en nadadores de 8 a 15 años de edad. Se estudiaron 42 nadadores, después de 15 semanas de entrenamiento se formaron 2 grupos, los que disminuyeron (A) y aumentaron (B) MLG. Se encontró que el grupo A redujo el peso y la masa muscular mientras que en el grupo B aumentó. En el grupo A se observó una disminución en los linfocitos, un aumento en la urea sérica, una disminución en el VO2 y en la recuperación a un minuto. La reducción de la MLG se asoció con alteraciones fisiológicas que reducen el rendimiento deportivo

An increase in fat-free mass (FFM) improves athletic performance. The aim of this study was to determine if a decrease in the FFM, expressed as the AKS index, is associated with physiological alterations after a training period in swimmers between 8-15 years old. Forty-two swimmers participated in this study, after 15 weeks of training the swimmers were divided into two groups, those who decreased (A) and those who increased FFM (B). In group A there was a decrease in both, body weight and muscle mass, while in group B there was an increase in body weight. We found that group A showed a reduction in lymphocytes count, in addition to an increase in serum urea, a decrease in VO2, and a decrease in their 1 min recovery. We showed here that a reduction in FFM is positively associated with physiological alterations that reduce athletic performance

Qué, cómo y cuánto debe hacer un residente de Medicina Familiar y Comunitaria para ser un buen especialista / What, how, and how much should a Family and Community Medicine resident do to become a good specialist?

Objetivo: Determinar cuál es el volumen idóneo de actividad que deben llevar a cabo los residentes de Medicina Familiar y Comunitaria para adquirir las competencias propias de su desempeño profesional. Material y método: Se recogió la opinión consensuada de un grupo de expertos en formación de residentes en Medicina Familiar y Comunitaria mediante una encuesta realizada con el método Delphi vía online en la que participaron 152 tutores. Resultados: La mediana total obtenida en las diferentes actividades a desarrollar por los residentes de Medicina Familiar y Comunitaria son: intervenciones individuales diagnósticas/terapéuticas: retinografías 60, espirometrías 40, anticoagulación 45, crio/electrocoagulación 35, infiltraciones 45, teledermatología 60, otras 45; salud mujer: embarazo 45, ecografía ginecológica/DIU 41, citologías 32,5, planificación 19,5, educación maternal 17; intervenciones estilo vida y cuidados: geriatría 30, enfermería 45, tabaco individual 30, grupal 15, problemas salud 15, consejo dietético 15; intervención comunitaria: sesiones con jóvenes 15, riesgo social 15; formación: sesiones 40, continuada 40

Objective: To determine the ideal volume of activity to be carried out by residents in Family and Community Medicine in order to acquire the competencies of their professional activity. Material and method: The consensus opinion of a group of experts in the training of residents in Family and Community Medicine was collected from 152 tutors using an online Delphi-type questionnaire. Results: The overall medians obtained in the different activities that should be developed by residents of Family and Community Medicine were: individual diagnostic/therapeutic interventions: retinography 60, spirometry 40, anticoagulation 45, cryo/electrocoagulation 35, infiltrations 45, tele-dermatology 60, and others 45; women's health: pregnancy 45, gynaecological ultrasound/IUD 41, cytology 32.5, family planning 19.5, and maternal education 17; lifestyle and care interventions: geriatrics 30, nursing 45, individual tobacco advice 30, group advice 15, health problems 15, and dietary advice 15; community intervention: sessions with youth 15, and social risk 15; training: sessions 40, continuing education 40. Conclusions: This information has defined the activity volumes that should be developed by the residents in order to acquire an adequate level of competence in the areas of individual diagnostic and therapeutic interventions, women's health, interventions to change lifestyles, community intervention, and clinical and training sessions. The consensus obtained could serve as a basis for the creation of a road map in the training of residents as a complementary tool to the Resident's Book, which is obligatory in all specialties

[What, how, and how much should a Family and Community Medicine resident do to become a good specialist?] / Qué, cómo y cuánto debe hacer un residente de Medicina Familiar y Comunitaria para ser un buen especialista.

OBJECTIVE: To determine the ideal volume of activity to be carried out by residents in Family and Community Medicine in order to acquire the competencies of their professional activity. MATERIAL AND METHOD: The consensus opinion of a group of experts in the training of residents in Family and Community Medicine was collected from 152 tutors using an online Delphi-type questionnaire. RESULTS: The overall medians obtained in the different activities that should be developed by residents of Family and Community Medicine were: individual diagnostic/therapeutic interventions: retinography 60, spirometry 40, anticoagulation 45, cryo/electrocoagulation 35, infiltrations 45, tele-dermatology 60, and others 45; women's health: pregnancy 45, gynaecological ultrasound/IUD 41, cytology 32.5, family planning 19.5, and maternal education 17; lifestyle and care interventions: geriatrics 30, nursing 45, individual tobacco advice 30, group advice 15, health problems 15, and dietary advice 15; community intervention: sessions with youth 15, and social risk 15; training: sessions 40, continuing education 40. CONCLUSIONS: This information has defined the activity volumes that should be developed by the residents in order to acquire an adequate level of competence in the areas of individual diagnostic and therapeutic interventions, women's health, interventions to change lifestyles, community intervention, and clinical and training sessions. The consensus obtained could serve as a basis for the creation of a road map in the training of residents as a complementary tool to the Resident's Book, which is obligatory in all specialties.

Sinovitis vellonodular pigmentada en rodilla y asociación a material extraño / Pigmented villonodular synovitis of the knee related to foreing material

Objetivos: Se pretende ver la asociación entre SVNP y la exposición a material extraño. Material y método: Analizamos retrospectivamente 201 pacientes sometidos a cirugía abierta durante 2016, dividiendo dicha muestra en 2 grupos, los pacientes con algún implante previo (PTR u osteosíntesis), y los que no habían tenido ningún material, las muestras de tejido sospechoso de proliferación fueron enviadas al anatomopatólogo, analizando los resultados con test Chi². Resultados: Se obtienen 7 casos de SVNP, de los cuales 6 de ellos habían estado en contacto con material extraño, tras analizar la asociación estadística, se obtiene una significación suficiente para aceptar que pueda haber relación entre la exposición a material y SVNP. Conclusión: La SVNP es una enfermedad rara, de etiología incierta, varías hipótesis intenta explicar el origen: alteraciones citogenéticas o cromosómicas, enfermedades que cursen con hemorragias articulares, traumatismos de repetición hiperplasia inflamatoria del tejido sinovial. Comunicaciones recientes han relacionado la etiología de la SVNP con una reacción del tejido sinovial a cuerpo extraño en cadera y rodilla, y con el presente trabajo se recalca la asociación entre material extraño y la aparición de esta rara entidad

Objectives: It is intended to approach the association between PVNS and exposure to foreign material. Material and method: We retrospectively analyzed 201 patients undergoing open surgery during 2016, dividing the sample into 2 groups, those with a previous implant (TKA or osteosynesis), and those who had not had any material, samples of tissue suspected of proliferation were sent to the anatomopathologist, analyzing the results using Chi² test Results: 7 cases of PVNS were obtained, of which 6 had been in contact with foreign material, after analyzing the statistical association, a sufficient significance was obtained to accept that there may be a relationship between the exposure to material and PVNS. Conclusion: PVNS is a rare disease of uncertain etiology, several hypotheses try to explain the origin: cytogenetic or chromosomal alterations, diseases that occur with joint hemorrhages, recurrent trauma, inflammatory hyperplasia of synovial tissue. Recent reports have linked the etiology of PVNS with a reaction of foreign body synovial tissue in the hip and knee, and the present work emphasizes the association between foreign material and the appearance of this rare entity

Siliconomas axilares en pacientes con melanoma / Axillary Silicone Granulomas in Patients With Melanoma

Durante el seguimiento de pacientes con melanoma podemos detectar lesiones subcutáneas cuyo principal diagnóstico diferencial son las metástasis en tránsito o las adenopatías metastásicas. Se describen 2 mujeres con melanoma portadoras de prótesis mamarias que presentaron durante su seguimiento lesiones subcutáneas palpables en la región axilar. El estudio ecográfico puso de manifiesto en ambos casos la existencia de imágenes hiperecogénicas difusas en «tormenta de nieve» localizadas en el tejido subcutáneo. En estos casos la ecografía se posiciona como herramienta diagnóstica fundamental para el despistaje de procesos relacionados con el melanoma, como las metástasis en tránsito o las adenopatías metastásicas

Subcutaneous lesions may be detected during follow-up of patients with melanoma. The main entities that should be contemplated in the differential diagnosis in such cases are in-transit and regional lymph node metastases. We describe 2 cases of women with breast implants who developed palpable subcutaneous lesions in the axillary region during follow-up of melanoma. In both cases, the ultrasound study showed diffuse hyperechoic signals forming the characteristic snowstorm sign in the subcutaneous tissue. Ultrasound proved to be a key diagnostic tool for ruling out melanoma-related disease, such as in-transit metastases and regional lymph node metastases

Axillary Silicone Granulomas in Patients With Melanoma. / Siliconomas axilares en pacientes con melanoma.

Subcutaneous lesions may be detected during follow-up of patients with melanoma. The main entities that should be contemplated in the differential diagnosis in such cases are in-transit and regional lymph node metastases. We describe 2 cases of women with breast implants who developed palpable subcutaneous lesions in the axillary region during follow-up of melanoma. In both cases, the ultrasound study showed diffuse hyperechoic signals forming the characteristic snowstorm sign in the subcutaneous tissue. Ultrasound proved to be a key diagnostic tool for ruling out melanoma-related disease, such as in-transit metastases and regional lymph node metastases.

Ecografía aplicada al manejo del melanoma maligno cutáneo / Ultrasound applied to the management of malignant melanoma

En las últimas décadas, la ecografía cutánea ha adquirido un protagonismo creciente en el ámbito de la dermatología. Hasta el momento son múltiples sus aplicaciones, tanto en patología inflamatoria como en patología tumoral. De hecho, el melanoma es uno de los tumores que más se ha beneficiado de sus avances tecnológicos, tanto para el diagnóstico inicial como para el seguimiento. Tal es así que hoy en día la ecografía cutánea se ha posicionado como herramienta diagnóstica no invasiva, cuyas principales aplicaciones en el campo del melanoma son determinar el espesor tumoral y analizar la vascularización intratumoral, con objeto de conocer factores pronósticos a tiempo real, así como ayudar al diagnóstico de metástasis subcutáneas y ganglionares durante la estadificación inicial y durante el seguimiento con objeto de disminuir la morbimortalidad

In the last few decades, the role of cutaneous ultrasound has increased in dermatology. This technique currently has multiple applications, both in inflammatory and tumoural disease. Indeed, melanoma is one of the tumours benefitting most from technological advances in ultrasound, both for initial diagnosis and for follow-up. Today, cutaneous ultrasound is a noninvasive diagnostic technique, whose main applications in melanoma are to determine tumoural thickness and analyse intratumoural vascularisation. This allows prognostic factors to be determined in real time and contributes to the diagnosis of subcutaneous and nodal metastases during initial staging and follow-up with a view to reducing morbidity and mortality

Dentate gyrus expression of nestin-immunoreactivity in patients with drug-resistant temporal lobe epilepsy and hippocampal sclerosis.

PURPOSE: Granule cells pathology in dentate gyrus, have received considerable attention in terms of understanding the pathophysiology of temporal lobe epilepsy with hippocampal sclerosis. The aim of this study was to determine the nestin (an intermediate filament protein expressed by newly formed cells), immunoreactivity (IR) in granular cells layers of hippocampal tissue extirpated during epilepsy surgical procedure, in patients with drug-resistant epilepsy. METHODS: Hippocampal sections of 16 patients with hippocampal sclerosis and drug-resistant temporal lobe epilepsy were processed using immunoperoxidase with antibody to nestin. Archival material from 8 normal post-mortem hippocampus, were simultaneously processed. Reactive area for nestin-IR, the total number of positive nestin cells per field (20×), and the MGV (mean gray value) was determined by computerized image analysis (ImageJ), and compared between groups. Student's t test was used for statistical analysis. RESULTS: Nestin-IR cells were found in granule cells layers of both controls and patients. Larger reactive somas (p < 0.01) were found in epileptic's sections but a significant reduction in the total number of nestin-IR cells per field and in the MGV was found in granular cells layers of patients with hippocampal sclerosis (p < 0.01). CONCLUSION: Reduced expression of nestin-IR in granular cells layers of epileptic's dentate gyrus may reflect changes in dentate gyrus neuroplasticity associated to chronic temporal epilepsy with hippocampal sclerosis. Further studies are required to determine the clinical implications on memory an emotional alterations such as depression.

[Ultrasound applied to the management of malignant melanoma]. / Ecografía aplicada al manejo del melanoma maligno cutáneo.

In the last few decades, the role of cutaneous ultrasound has increased in dermatology. This technique currently has multiple applications, both in inflammatory and tumoural disease. Indeed, melanoma is one of the tumours benefitting most from technological advances in ultrasound, both for initial diagnosis and for follow-up. Today, cutaneous ultrasound is a noninvasive diagnostic technique, whose main applications in melanoma are to determine tumoural thickness and analyse intratumoural vascularisation. This allows prognostic factors to be determined in real time and contributes to the diagnosis of subcutaneous and nodal metastases during initial staging and follow-up with a view to reducing morbidity and mortality.

Chronic administration of thiamine pyrophosphate decreases age-related histological atrophic testicular changes and improves sexual behavior in male Wistar rats.

Aging is a multifactorial universal process and constitutes the most important risk factor for chronic-degenerative diseases. Although it is a natural process, pathological aging arises when these changes occur quickly and the body is not able to adapt. This is often associated with the generation of reactive oxygen species (ROS), inflammation, and a decrease in the endogenous antioxidant systems, constituting a physiopathological state commonly found in chronic-degenerative diseases. At the testicular level, aging is associated with tissue atrophy, decreased steroidogenesis and spermatogenesis, and sexual behavior disorders. This situation, in addition to the elevated generation of ROS in the testicular steroidogenesis, provides a critical cellular environment causing oxidative damage at diverse cellular levels. To assess the effects of a reduction in the levels of ROS, thiamine pyrophosphate (TPP) was chronically administered in senile Wistar rats. TPP causes an activation of intermediate metabolism routes, enhancing cellular respiration and decreasing the generation of ROS. Our results show an overall decrease of atrophic histological changes linked to aging, with higher levels of serum testosterone, sexual activity, and an increase in the levels of endogenous antioxidant enzymes in TPP-treated animals. These results suggest that TPP chronic administration decreases the progression of age-related atrophic changes by improving the intermediate metabolism, and by increasing the levels of antioxidant enzymes.

El informe de la radiología simple. Algo más que un imperativo legal / Reporting plain films: more than just a legal requirement

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Tendencia y estacionalidad del virus respiratorio sincitial en Valladolid durante el periodo 1993-2010 / Trend and seasonality of respiratory syncytial virus in Valladolid (Spain) during 1993-2010

Objetivo: Describir la tendencia y la estacionalidad de las infecciones por el virus respiratorio sincitial (VRS) en el Área de Salud de Valladolid Este durante el periodo 1993-2010.Pacientes y métodos: Se incluyeron en el estudio las muestras analizadas entre enero de 1993 y diciembre de 2010 por el Servicio de Microbiología e Inmunología del Hospital Clínico Universitario de Valladolid. Las muestras se clasificaron en función de la edad del paciente y el método de diagnóstico. El análisis virológico se llevó a cabo mediante técnicas de diagnóstico rápido, cultivo celular o microarrays. Se calcularon las tasas anuales referidas al área cubierta por el hospital para identificar la tendencia desde 1993 hasta 2010. Los meses epidémicos se establecieron mediante el índice epidémico, y la periodicidad mediante el método cosinor. Resultados: De 4.103 muestras analizadas de pacientes con síntomas respiratorios, en 1.644 (40,1%) se confirmó la presencia de VRS. Casi el 90% de los casos confirmados se dieron en pacientes menores de 2 años, y el 59,5% en menores de 1 año. Las tasas fluctuaron cada 2-4 años, alcanzando valores máximos en 2002 y 2003, con 41,5 y 44,9 casos por 100.000 habitantes-año, respectivamente. Aunque se produjeron casos durante todo el año, los periodos epidémicos se dieron entre septiembre y marzo, detectándose la mayor incidencia en enero y la menor en julio. Conclusiones: Los datos epidemiológicos (prevalencia del virus en muestras respiratorias y distribución por edad) fueron similares a los descritos en otros estudios. Los periodos epidémicos se describieron entre septiembre y marzo, alcanzado el máximo de incidencia en enero y el mínimo en julio. A pesar de ello, a lo largo de los 18 años estudiados sólo en 5 años no hubo circulación de VRS durante 2-3 meses, y en 8 más el VRS estuvo ausente durante un mes. No hay ningún dato que permita anticipar la ausencia de circulación del virus, aspecto importante para la profilaxis de esta infección (AU)

Purpose: The aim of the study is to describe the trend and seasonality of respiratory syncytial virus (RSV) infections in the East Valladolid Health Administrative-Division during the period1993-2010.Patients and Methods: Samples processed in the area of Eastern Valladolid by the Department of Microbiology and Immunology at the Hospital Clínico Universitario of Valladolid between January 1993 and December 2010 were included in the analysis. Cases were classified by age and diagnostic method. Virological diagnosis of the cases was carried out through rapid assay methods, shell-vial cell culture assay or microarray techniques. Annual rates were calculated to identify the trend of the infection from 1993 to 2010. The epidemic index was used to establish epidemic months and cosinor method to evaluate periodicity. Results: From 4,103 samples processed, collected from patients with respiratory symptoms, 1,644 (40.1%) were confirmed to be RSV possitive. Almost 90% of the confirmed cases appeared in patients under 2 years old, 59.5% in younger than1 year old children. The infection trend seems to fluctuate every 2-4 years with higher rate in 2002 and 2003, accounting for 41.5 and 44.9 cases detected per 100,000 inhabitants-year, respectively. Although cases were detected throughout all the year, epidemic periods were detected from September to March with highest values in January and lowest values in July. Conclusions: Epidemiological data (VRS prevalence in respiratory samples and distribution of cases by age) was similar to those obtained in previous studies. Epidemic periods were described from September to March with the highest numbers of cases in January and lowest values in July. In spite of this, along the eighteen years studied there were eight years without RSV detection in one month and only five years without detection in 2-3 months. There is no data that allows to predict the lack of circulation for RSV, being an important factor for the prophylaxis of the infection (AU)

Crossed aphasia after right anterior temporal lobectomy. A case report.

The occurrence of crossed aphasia as a complication after temporal lobe epilepsy surgery is extremely rare. We report the case of a 47-year-old right-handed patient with drug-resistant mesial temporal lobe epilepsy (MTLE) who developed a transitory aphasic syndrome after a right temporal anterior lobectomy. This syndrome was characterized by anomia, poor verbal fluency, verbal perseveration, and verbal comprehension difficulties. He also showed writing difficulties, reading substitutions, and calculation task errors. The patient was regularly assessed with language tasks, and showed a spontaneous and progressive recovery of his symptoms, with remaining naming difficulties. We discuss the role that epileptogenic zone could play in cortical reorganization of the language systems.

A study of word finding difficulties in Spanish speakers with temporal lobe epilepsy.

It is well established that naming deficits can be found in temporal lobe epilepsy (TLE). The aim of this study was to determine in Spanish speakers with pharmacoresistant TLE the characteristics of subjective naming difficulties and to examine performance in a definition task and a picture task in left TLE and right TLE. We observed that almost one-third of patients report frequent and severe word finding problems during spontaneous speech. In naming tests, our patients exhibited delayed times for finding words. Even if the target word was identified and semantically activated, there was difficulty with lexical access, which improved when a phonetic cue was given. Left TLE patients derived a lower benefit from phonetic cues in accessing words, even when the word is known and recognized semantically. These findings were not related to any demographic or clinical characteristics analyzed. The fact that the only weakly lateralized variable has been a lexical access facilitation measurement could support a lexical access hypothesis for naming deficits in TLE.