Valoración de la satisfacción materna con la analgesia epidural para el trabajo del parto / Assessment of maternal satisfaction with epidural analgesia during labour

Objetivos. Conocer el grado de satisfacción de las pacientes obstétricas a las que se les realiza la técnica epidural para el trabajo de parto. Material y métodos. Encuestas realizadas durante tres meses a las pacientes ingresadas en el Hospital Universitario Virgen de las Nieves (HUVN) a las que se les aplicó la técnica epidural para control del dolor para el parto. Resultados. Se recogieron 100 encuestas de un total de 105. La satisfacción media global de las pacientes (puntuación SERVQHOS) fue de 3,98 con una desviación estándar, DE±0,64 con mejor resultado en las cuestiones subjetivas: 4,10 con DE±0,68 y menor en las objetivas con 3,86 y DE±0,73. El 92% de las pacientes se mostraron satisfechas con la analgesia epidural, con un intervalo de confianza, IC al 95% entre 87-97%. El análisis de los factores demográficos no mostró asociación estadísticamente significativa entre la edad de las pacientes y un mayor grado de satisfacción; tampoco se encontraron diferencias estadísticamente significativas entre la nacionalidad y la valoración de la satisfacción con la técnica epidural. El grado de recomendación posterior fue de 98% en las pacientes satisfechas y 85,7% en las no satisfechas. Conclusiones. La proporción de pacientes satisfechas con la técnica fue muy elevada, siendo los aspectos subjetivos los mejor valorados (trato y confianza en profesionales)(AU)

Objective. To measure the overall satisfaction of obstetrics patients with epidural analgesia during labour, and in particular, with the technique and other subjective factors. Material and methods. An anonymous questionnaire was administered over a three-month period to patients who received analgesia to control pain during labour and who had vaginal delivery, in order to obtain information of the satisfaction with technique and their care. Results. Of the 100 patients who responded to the questionnaire, 92% were satisfied with the technique. The mild satisfaction measured by SERVQHOS score was 3.98 (SD±0.64). The score for the subjective aspects was 4.10 (± 0.68), which was better than objective ones. The recommendation rate was 98% for satisfied patients and 85.7% for those who were not satisfied. There were no differences between Spanish and foreign patients in their evaluation of the satisfaction. Conclusions. The proportion of patients satisfied with the technique was very high, and was the top rated subjective aspect (treatment and public confidence)(AU)

Implantación de un test de detección rápida de estreptococo betahemolítico del grupo A en la consulta de Atención Primaria / No disponible

Objetivos: analizar el beneficio teórico que supondría la implantación de un test de detecciónrápida para la identificación del Streptococcus pyogenes (EGA) en exudado faríngeode niños con faringoamigdalitis aguda en la consulta de Atención Primaria (AP). Diseño: tipo de estudio: observacional, descriptivo. Se recogieron muestras de exudadofaringoamigdalar para cultivo de niños de 0-14 años atendidos en AP con sospecha de faringoamigdalitis aguda estreptocócica (FAE). Se excluyó a los que presentaban sospecha clínica de faringitis vírica. Se los clasificó, en función de la clínica, en: sospecha alta e intermediade infección estreptocócica. Resultados: se analizaron los datos de 62 pacientes, de los que 30 (49%) fueron catalogadosde sospecha alta y 32 (51%) de sospecha intermedia. Se aisló EGA en el cultivo de 24 pacientes (34,7%), 20 de los cuales pertenecían al grupo de sospecha alta. Recibieron tratamiento antibiótico 53 pacientes (85,5%): los 30 con sospecha alta y 23 del grupo con sospecha intermedia. Encontramos una asociación estadísticamente significativa (p < 001) entre los resultados obtenidos en el cultivo y la sospecha clínica de FAE. Se observó una relación significativa entre la sospecha clínica y el tratamiento antibiótico y entre los resultados del cultivo y la prescripción de antibióticos. Conclusiones: la prescripción inadecuada de antibióticos fue alta. Las técnicas rápidas de detección del EGA permiten identificar fácilmente la etiología estreptocócica e indicar, de forma selectiva y eficaz, la terapia antibiótica (sensibilidad y especificidad altas). Si hubiésemos tomado la decisión de pautar antibióticos teniendo en cuenta el resultado de untest de detección rápida, el número de prescripciones inadecuadas hubiese sido menor. Eltest de detección rápida debería ser una técnica común en AP

Objectives: to analyze the theoretical benefit of introducing a rapid detection test to identify Streptococcus pyogenes (SGA) in pharynx exudate of children with acute tonsilopharyngitis in the Primary Care (PC) setting. Study design: observational descriptive. Exudate pharynx samples for culture were collected from children 0-14 years visited in PC with suspected acute streptococic tonsilopharyngitis (AST). Children with suspected viral pharyngitis were excluded. They were classified according to the clinic presentation in: high and intermediate suspicion of streptococcal infection. Results: data from 62 patients were analyzed, 30 (49%) of them were classified as high suspicion and 32 (51%) as intermediate suspicion. SGA was isolated in the culture of 24 patients (34.7%), 20 of them belonging to the high suspicion group. Fifty two patients received antibiotic treatment (85.5%): the 30 high suspicion patients and 23 from the intermediate suspicion group. Statistic significant association is found (p < 0,001) between the culture results and the clinical suspicion of AST. Also a statistic significant association is found between the clinical suspicion and the antibiotic treatment and between the culture results and antibiotic prescription. Conclusions: inadequate antibiotic prescription was high. The rapid techniques of SGA detection make possible to easily identify the streptococcal aetiology and prescribe, in a selective and efficient way, the antibiotic treatment (high sensitivity and specificity). If we had taken the decision of prescribing antibiotics taking into account the result of a rapid detection test, the number of inadequate prescriptions would had been smaller. Rapid detection tests should be a common technique in PC

Acute exercise activates nuclear factor (NF)-kappaB signaling pathway in rat skeletal muscle.

Two studies were performed to investigate the effects of an acute bout of physical exercise on the nuclear protein kappaB (NF-kappaB) signaling pathway in rat skeletal muscle. In Study 1, a group of rats (n=6) was run on the treadmill at 25 m/min, 5% grade, for 1 h or until exhaustion (Ex), and compared with a second group (n=6) injected with two doses of pyrrolidine dithiocarbamate (PDTC, 100 mg/kg, i.p.) 24 and 1 h prior to the acute exercise bout. Three additional groups of rats (n=6) were injected with either 8 mg/kg (i.p.) of lipopolysaccharide (LPS), 1 mmol/kg (i.p.) t-butylhydroperoxide (tBHP), or saline (C) and killed at resting condition. Ex rats showed higher levels of NF-kappaB binding and P50 protein content in muscle nuclear extracts compared with C rats. Cytosolic IkappaBalpha and IkappaB kinase (IKK) contents were decreased, whereas phospho-IkappaBalpha and phospho-IKK contents were increased, comparing Ex vs. C. The exercise-induced activation of NF-kappaB signaling cascade was partially abolished by PDTC treatment. LPS, but not tBHP, treatment mimicked and exaggerated the effects observed in Ex rats. In Study 2, the time course of exercise-induced NF-kappaB activation was examined. Highest levels of NF-kappaB binding were observed at 2 h postexercise. Decreased cytosolic IkappaBalpha and increased phosphor-IkappaBalpha content were found 0-1 h postexercise whereas P65 reached peak levels at 2-4 h. These data suggest that the NF-kappaB signaling pathway can be activated in a redox-sensitive manner during muscular contraction, presumably due to increased oxidant production. The cascade of intracellular events may be the overture to elevated gene expression of manganese superoxide dismutase reported earlier (Pfluegers Arch. 442, 426-434, 2001).