Factores pronósticos y análisis de la mortalidad de las hemorragias cerebrales asociadas a anticoagulantes orales antagonistas de la vitamina K. Resultados del estudio TAC Registry / Prognostic factors and analysis of mortality due to brain haemorrhages associated with vitamin K antagonist oral anticoagulants. Results from the TAC Registry

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A construção do Jornal do Centro de Atenção Psicossocial II: desenvolvendo habilidades específicas e relacionais / Editing the Center for Psychosocial Care: developing hard and soft skills

Objetivo: demonstrar as possibilidades de uma oficina multiprofissional no desenvolvimento de habilidades específicas e de relacionamento. Métodos: relato de experiência descrevendo a construção do Jornal do Centro de Atenção Psicossocial (CAPS). Resultados: empoderamento através do aprendizado de ferramentas como computador e internet; desenvolvimento de capacidades relacionais, como liderança, autonomia, exposição de ideias e trabalho em equipe. Considerações finais: destaca-se o potencial de uma atividade organizadora, cujo produto final é um material impresso, para o crescimento e desenvolvimento de competências e habilidades específicas e relacionais, aspectos importantes para a efetiva reinserção social.

Objective: to demonstrate the possibilities of a multidisciplinary workshop on developing hard andsoft skills to improve rehabilitation. Methods: experience’s description of conducting a workinggroup aimed to writing and editing a newspaper. Through such specific task, different hard and softskills are developed. Hard skills are specific abilities, such as using the computer and the internet,whereas soft skills are social skills, such as how to relate to others and negotiate. Results:empowerment of the clients by enhancing abilities with tools like the computer and the internet;Development of relational capacities, such leadership and group working. Final considerations: thismultidisciplinary therapeutic workshop is useful to enhance clients’ work and social skills and improve their rehabilitation process.

Tratamiento de las úlceras por presión con Aloe Vera / No disponible

Objetivos: Presentar una información actualizada acerca de la aplicación del Aloe Vera en las úlceras por presión (UPP). Material y métodos: Búsqueda bibliográfica de los artículos publicados, entre 2004 y 2014, en diferentes bases de datos biomédicas. Resultados: La evidencia confirma que puede ayudar en la prevención y en el tratamiento de UPP de grado I y II. Sin embargo no existen referencias que justifiquen su uso en las UPP III y IV. Conclusiones: La Organización Mundial de la Salud (OMS) recomienda a los gobiernos que sitúen la seguridad del paciente en el centro de las Políticas Sanitarias, destacando medidas cómo la prevención y el tratamiento de las UPP

Objectives: To show updated information about the implementation of Aloe Vera in the treatment of pressure ulcers. Material and methods: Literature search of articles published, between 2004 and 2014, in different biomedical databases. Results: The evidence confirms that Aloe Vera can help in the prevention and treatment of pressure ulcers of grade I and II. However, there are no references that justify its use in pressure ulcers III and IV. Conclusions: The World Health Organization (WHO) recommends that governments put patient safety at the center of Health Policy, emphasizing measures like prevention and treatment of pressure ulcers

SEOM clinical guidelines for the management of metastatic breast cancer 2013

Patients with metastatic breast cancer should be offered comprehensive and personalized medical attention including, but not limited to, psychosocial, supportive and symptom-related interventions. A large number of treatment options are available and several prognostic and predictive factors are useful to identify the best therapeutic options individually (AU)

SEOM clinical guidelines for the management of metastatic breast cancer 2013.

Patients with metastatic breast cancer should be offered comprehensive and personalized medical attention including, but not limited to, psychosocial, supportive and symptom-related interventions. A large number of treatment options are available and several prognostic and predictive factors are useful to identify the best therapeutic options individually.

The HUGE formula (hematocrit, urea and gender): association with cardiovascular risk.

OBJECTIVES: To evaluate the relationship between chronic renal failure (CFR) defined through HUGE (hematocrit, urea and gender) formula score and the patient's cardiovascular risk measured through cardiovascular disease antecedents such as ischemic cardiopathy, cerebrovascular disease and peripheral arterial disease. DESIGN AND METHODS: The sample consisted of 2,831 subjects. Mean age was 51.2±14.7 years and 53.5% were female. Serum creatinine, urea, hematocrit and 24h proteinuria were analyzed. HUGE score was calculated from gender, urea and hematocrit. GFR was estimated from uncalibrated serum creatinine using the abbreviated Modification of Diet in Renal Disease equation (MDRD-4). UAE was measured in first morning urine sample. RESULTS: Using HUGE formula 2.2% (n = 61) of subjects had CRF. Of them, 12 (19.7%) had cardiovascular disease history. Among patients without CRF (n = 2770), 194 subjects had history of previous cardiovascular diseases (0.07%; p < 0.001 Square Chi test). Using the MDRD-4 formula 4.0% of subjects (n = 113) had a GFR < 60 ml/min. Of them, 18 (15.9%) had cardiovascular disease history. Among patients without CRF (n = 2718), 188 subjects had history of previous cardiovascular diseases (0.07%; p < 0.001 Square Chi test). Odd's ratio for cardiovascular diseases using HUGE definition of CRF was 3.25 (p = 0.001, Mantel-Haenszel test). CFR was associated to higher pulse pressure (PP) and increased urinary albumin excretion. CONCLUSIONS: A significant cardiovascular risk was associated to the diagnosis of CRF through HUGE formula. This relation was closer than the obtained using MDRD estimated GFR in spite of a bigger sample. HUGE formula seems to be a useful tool for diagnosing CRF and evaluate the cardiovascular risk of these patients.

Prevalence of abnormal urinary albumin excretion in elderly people: a Spanish survey.

OBJECTIVES: HERMEX is a population-based study, which tries to evaluate the prevalence of cardiovascular risk factors in the population of Extremadura, Spain. This report provides the data concerning albuminuria in the elderly people recruited in the survey. DESIGN AND METHODS: 3,402 subjects were randomly selected from the database of the Health Care System of Extremadura. The final sample included 2,813 subjects (mean age 51.2 years, 53.5 % female). Urinary albumin excretion rate (UAER) in the first morning urine sample was analyzed. Albuminuria was diagnosed when UAER (albumin-to-creatinine ratio) was ≥ 22 mg/g in men or ≥ 31 mg/g in women. RESULTS: The prevalence of abnormal UAER in the elderly population was 10.9 % (microalbuminuria: 8.9 %; overt proteinuria: 1.8 %). The younger subjects showed a lower prevalence of microalbuminuria (3.4 %, p < 0.001). Elderly patients showed a higher prevalence of cardiovascular risk factors than the younger ones. The elderly had higher systolic blood pressure and pulse pressure than the younger ones. Furthermore, the elderly subjects had lower plasma levels of HDL cholesterol, but higher triglycerides, glucose, creatinine, and glycosylated hemoglobin; no differences were found for total and LDL cholesterol. When the prevalence of causes of microalbuminuria was compared between age groups, we found a sharp increase in diabetic and, especially, hypertensive patients in the elderly group. The multivariate analysis showed an independent association of microalbuminuria with systolic blood pressure and plasma creatinine. CONCLUSIONS: A high prevalence of abnormal UAER in elderly people was detected in a randomly selected sample of Spanish general population. In most elderly patients, microalbuminuria was associated with high blood pressure and, less frequently, with diabetes mellitus.

[Mass maritime casualty incidents in German waters: structures and resources]. / Massenanfall von Verletzten auf See in deutschen Gewässern : Strukturen und Ressourcen.

The Central Command for Maritime Emergencies was founded in Germany in 2003 triggered by the fire on board of the cargo ship "Pallas" in 1998. Its mission is to coordinate and direct measures at or above state level in maritime emergency situations in the North Sea and the Baltic Sea. A special task in this case is to provide firefighting and medical care. To face these challenges at sea emergency doctors and firemen have been specially trained. This form of organization provides a concept to counter mass casualty incidents and peril situations at sea. Since the foundation of the Central Command for Maritime Emergencies there have been 5 operations for firefighting units and 4 for medical response teams. Assignments and structure of the Central Command for Maritime Emergencies are unique in Europe.

Individualization of treatment strategies.

This section focuses on different aspects of the individualization of hormone treatment in breast cancer. This includes tumor-related biological factors such as expression of hormone receptors, HER-2, and Ki-67; host-related factors such as CYP2D6 or body mass index, and risk and/or development of specific toxicities and treatment adherence. The best predictor of response to hormonal interventions is the expression of hormone receptors, in particular, estrogen receptors. Treatment adherence and compliance are key factors and strategies aiming to identify and intervene when patients are at risk of abandoning treatment. Currently, routine assessment of CYP2D6 is not recommended to guide tamoxifen treatment. Likewise, there are no criteria regarding bone mass density, lipid profile, or arthralgias to recommend one class of agent versus another. Aromatase inhibitors should not be administered to patients who are pre- or perimenopausal.

Efectos de la rapamicina en los angiomiolipomas de pacientes con esclerosis tuberosa / Effects of rapamycin on angiomyolipomas in patients with tuberous sclerosis

Introducción: La esclerosis tuberosa (ET) es una enfermedad sistémica, de herencia autosómica dominante, ocasionada por mutaciones en dos genes (TSC1 y TSC2), que causan la aparición de tumores (angiolipomas [AML], angiofibromas, astrocitomas, etc.). La proliferación inadecuada y constante que existe en la ET puede ser bloqueada por inhibidores de la kinasa mTOR (mammalian target of rapamycin), como la rapamicina. Material y métodos: Se han incluido 17 pacientes afectados de ET y, al menos, un AML mayor de 2 cm de diámetro diagnosticado por resonancia magnética (RM). Han recibido tratamiento con rapamicina durante 12 meses. Los niveles plásmáticos se han mantenido entre 4 y 8 ng/dl. El tamaño del AML se ha monitorizado semestralmente mediante RM abdominal. Resultados: A los 12 meses de la inclusión, con la RM se ha objetivado una disminución del tamaño del AML en todos los pacientes incluidos, mostrando una reducción de, al menos, un 50% en el 82,4% (14/17; intervalo de confianza [IC] 95% [56,57%, 96,20%]). El porcentaje medio de reducción fue del 66,3% (IC95 [56,9%, 75,6%]; p <0,0001). Los principales efectos secundarios observados han sido: aftas orales (5/17); hipertrigliceridemia (3/17); microcitosis e hipocromía (3/17); diarrea (2/17); acné (1/17); pielonefritis aguda (1/17), y proteinuria (1/17). Conclusiones: Los datos clínicos preliminares sugieren que la rapamicina puede desempeñar un papel beneficioso en el tratamiento de la ET. Nuestra experiencia en 17 pacientes tratados durante 12 meses demuestra seguridad y eficacia en la reducción de AML (AU)

Background: Tuberous sclerosis (TS) is a systemic disease, with an autosomal dominant pattern of inheritance caused by mutations in two genes (TSC1 and TSC2) that cause tumours (angiomyolipomas [AML], angiofibromas, astrocytomas). Constant and inadequate proliferation occurring in TS may be blocked by mTOR inhibitors (mammalian target of rapamycin), such as rapamycin. Material and methods: At present, our study includes 17 patients with TS. All had at least one AML greater than 2cm in diameter diagnosed by MRI. They received rapamycin during 12 months. Plasma levels remained stable between 4-8ng/dl. The AML size was monitored every six months by abdominal MRI. Results: At 12 months of inclusion, MRI indicated a decrease in the size of AML in all patients showing at least a 50% reduction in 82.4% (14/17, 95% CI [56.57%, 96.20%]). The mean percent reduction was 66.3% (95% CI [56.9%, 75.6%], P<.0001). The major side effects observed were: oral aphthous ulcers (5/17); hypertriglyceridemia (3/17); microcytosis and hypochromia (3/17); diarrhea (2/17); acne (1/17); acute pyelonephritis (1/17); and proteinuria (1/17). Conclusions: These preliminary clinical data suggest that rapamycin can play a beneficial role in the treatment of TS. Our experience in 17 patients treated for 12 months demonstrates safety and efficacy in reducing AML volume (AU)

Valoración de la nueva ecuación CKD-EPI para la estimación del filtrado glomerular / Assessment of the new CKD-EPI equation to estimating glomerular filtration rate

Introducción: Recientemente el grupo CKD-EPI (ChronicKidney Disease Epidemiology Collaboration) ha publicado una nueva ecuación de estimación del filtrado glomerular(FG) desarrollada a partir de una población de 8.254 individuosa los que se midió el FG mediante aclaramiento de iotalamato (media 68 ml/min/1,73 m2, DE 40ml/min/1,73 m2), y que incluye como variables la creatinina sérica, la edad, el sexo y la raza, con distintas versiones en función de la etnia, el sexo y el valor de la creatinina. La ecuación de CKD-EPI mejoró los resultados en cuanto a exactitud y precisión de la ecuación de elección actual MDRD-IDMS (Modification of Diet in Renal Disease-Isotopic Dilution Mass Spectrometry) en especial para valores de FG superior a 60 ml/min/1,73 m2 en un grupo de 3.896individuos. Material y métodos: El objetivo de nuestro estudio fue comparar los valores de FG estimado utilizando la nueva ecuación de CKD-EPI frente a MDRD-IDMS en una amplia cohorte de 14.427 pacientes (5.234 mujeres y 9.193hombres) y analizar las repercusiones que el uso de CKDEPI tendría a la hora de clasificar a la población en distintos estadios de enfermedad renal crónica (ERC) en función de su FG. Resultados: La media del FG estimado fue 0,6ml/min/1,73 m2 más alto por CKD-EPI que por MDRD-IDMS en el grupo total, 1,9 ml/min/1,73 m2 más alto en el grupo (..) (AU)

Introduction: A recent report by the CKD-EPI Chronic Kidney Disease Epidemiology Collaboration) group describes a new equation to estimate the glomerular filtration rate (GFR).This equation has been developed from a population of8,254 subjects who had the GFR measured by iothalamate clearance (mean 68 ml/min/1.73 m2, SD 40 ml/min/1.73 m2).It includes variables such as serum creatinine, age, sex and race with different formula according to race, sex and creatinine value. The CKD-EPI equation improved the accuracy and precision results of the current first-choice MDRDIDMS(Modification of Diet in Renal Disease-Isotopic Dilution Mass Spectrometry) formula, specially for GFR >60ml/min/1.73 m2 in a group of 3,896 subjects. Methods: The goal of our study was to compare the estimated GFR by using the new equation CKD-EPI with MDRD-IDMS in a wide cohort of 14,427 patients (5,234 women and 9,193 men),and to analyze the impact of the new CKD-EPI formula on (AU)

[Assessment of the new CKD-EPI equation to estimate the glomerular filtration rate]. / Valoración de la nueva ecuación CKD-EPI para la estimación del filtrado glomerular.

INTRODUCTION: A recent report by the CKD-EPI Chronic Kidney Disease Epidemiology Collaboration) group describes a new equation to estimate the glomerular filtration rate (GFR). This equation has been developed from a population of 8,254 subjects who had the GFR measured by iothalamate clearance (mean 68 mL/min/1.73 m2, SD 40 mL/min/1.73 m2). It includes variables such as serum creatinine, age, sex and race with different formula according to race, sex and creatinine value. The CKD-EPI equation improved the accuracy and precision results of the current first-choice MDRD-IDMS (Modification of Diet in Renal Disease-Isotopic Dilution Mass Spectrometry) formula, specially for GFR > 60 mL/min/1.73 m2 in a group of 3,896 subjects. METHODS: The goal of our study was to compare the estimated GFR by using the new equation CKD-EPI with MDRD-IDMS in a wide cohort of 14,427 patients (5,234 women and 9,193 men), and to analyze the impact of the new CKD-EPI formula on the staging of patients with CKD. RESULTS: Mean estimated GFR was 0.6 mL/min/1.73 m2 higher with CKD-EPI as compared to MDRD-IDMS for the whole group, 1.9 mL/min/1.73 m2 higher for women and 0.2 mL/min/1.73 m2 lower for men. The percentage of CKD staging concordancy between equations varied from 79.4 % for stage 3A and 98.6% for stage 5. For those patients younger than 70 years, 18.9 % and 24 % MDRD-IDMS stages 3B and 3A were reclassified as CKD 3A and 2 by CKD-EPI, respectively. For the same stages in the group younger than 70 years, the percentage of reclassified patients increased up to 34.4% and 33.4%, respectively. CONCLUSION: The new CKD-EPI equation to estimate the GFR reclassifies an important number of patients to higher CKD stages (higher GFR), specially younger women, classified as CKD stage 3 by MDRD-IDMS.

[Fast track in vascular surgery]. / Fast Track in der Gefässchirurgie.

Vascular comorbidities are common in vascular surgery, being associated with perioperative complications. Since it was demonstrated that the postoperative course could be optimized by introduction of the fast track concept in general surgery, application to vascular surgery may also be of benefit. The fast track concept was introduced in our institution on May 1st 2008 with special adjustments for vascular surgery. The authors describe the development and implementation of a clinical pathway, which proved to be of value in vascular surgery.

Patient with resected anaplastic astrocytoma and an image suggestive of relapse.

The main treatment of asctrocytomas is surgery, which serves a double purpose: diagnosis and treatment. Surgery can be complemented with radiotherapy. With respect to chemotherapy, there continues to be a controversy as to whether it has the capacity to overcome the blood-brain barrier. An interesting option has been the implantation of biodegradable polymers of carmustine that are placed in the cavity left by the surgical procedure. With respect to the cerebral edema that can be associated with the carmustine implants, there can appear images in follow-up that are suggestive of relapse.

Patient with resected anaplastic astrocytoma and an image suggestive of relapse

The main treatment of asctrocytomas is surgery, which serves a double purpose: diagnosis and treatment. Surgery can be complemented with radiotherapy. With respect to chemotherapy, there continues to be a controversy as to whether it has the capacity to overcome the blood-brain barrier. An interesting option has been the implantation of biodegradable polymers of carmustine that are placed in the cavity left by the surgical procedure. With respect to the cerebral edema that can be associated with the carmustine implants, there can appear images in follow-up that are suggestive of relapse (AU)

Enfermedad de Marchiafava-Bignami en un paciente no alcohólico / Marchiafava-Bignami disease in a non-alcoholic patient

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[Ambulatory mouth surgery. Experience at a buccal-dental health unit in primary care]. / Cirugía oral ambulatoria. Experiencia en una unidad de salud bucodental en atención primaria.

OBJECTIVES: To describe the results obtained from conducting non-hospital mouth surgery in a buccal-dental health unit, to evaluate the quality of care and to monitor its evolution over two years. DESIGN: Descriptive, retrospective study with quality assessment methodology. PARTICIPANTS: Oral surgery interventions conducted during 1998 and 1999. SETTING: Primary care. Buccal-Dental Health Unit at Villanueva de la Serena. MEASUREMENTS AND MAIN RESULTS: 140 interventions took place in 1998 and 1999. 12 descriptive variables were analysed. 10 explicit standard quality criteria were worked out. Scientific and technical quality was measured through compliance rates. The radicular remains (28.6%) and the cordal remains included or retained (24.3%) were the most common diagnoses. The most frequently employed surgical procedures were: residual root extraction (28.6%) and the surgical extraction of included tooth (24.3%). 100% of users had signed an informed consent. In 9.9% of procedures a biopsy was performed: it gave 92.8% concordance with the diagnosis. In 1998, 6 of the 10 criteria scored above 90%. The mean of criteria satisfied per intervention was 7.4. There were clear deficiencies in anamnesis data collection (9.24%) and recording of post-operative complications (0% compliance). 60% of criteria did not achieve the standard. In 1999, 40% of criteria had a figure between 99 and 100%. 70% of criteria achieved the standard. The quantification of the improvement was significant in anamnesis (p < 0.001), analysis (p < 0.001) and post-operative complications (p < 0.001). CONCLUSIONS: Performing mouth surgery is a feasible non-hospital service. The quality cycle installed was highly effective.