Can the Dose of Belimumab be Reduced in Patients with Systemic Lupus Erythematosus?

OBJECTIVES: The aims of this study were to investigate the prevalence of dose reduction in patients with SLE treated with belimumab (BEL) in Spain, analyze treatment modalities, and determine impact on control of disease activity. METHODS: Retrospective longitudinal and multicentre study of SLE patients treated with BEL. Data on disease activity, treatments and outcomes were recorded before and after reduction (6-12 months), and they were compared. RESULTS: A total of 324 patients were included. The dose was reduced in 29 patients (8.9%). The dosing interval was increased in 9 patients receiving subcutaneous BEL and in 6 patients receiving intravenous BEL. The dose per administration was reduced in 16 patients.Pre-reduction status was remission (2021 DORIS) in 15/26 patients (57.7%) and LLDAS in 23/26 patients (88.5%). After reduction, 2/24 patients (8.3%) and 3/22 patients (13.6%) lost remission at 6 months and 12 months, respectively (not statistically significant [NS]). As for LLDAS, 2/23 patients (8.7%) and 2/21 patients (9.5%) lost their status at 6 and 12 months, respectively (NS). Significantly fewer patients were taking glucocorticoids (GCs) at their 12-month visit, although the median dose of GCs was higher at the 12-month visit (5 [0.62-8.75] vs 2.5 [0-5] at baseline). CONCLUSION: Doses of BEL can be reduced with no relevant changes in disease activity-at least in the short term-in a significant percentage of patients, and most maintain the reduced dose. However, increased clinical or serologic activity may be observed in some patients. Consequently, tighter post-reduction follow-up is advisable.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Estadificación axilar post-neoadyuvancia en pacientes con cáncer de mama con metástasis ganglionares al diagnóstico. Nuestra experiencia preliminar con biopsia selectiva de ganglio centinela y disección axilar dirigida guiada con semilla de iodo-125 / Post-neoadjuvant axillary staging in node-positive breast cancer patients. Preliminary experience with sentinel lymph node biopsy and targeted axillary dissection with iodine-125 seed

La expansión de la quimioterapia neoadyuvante en cáncer de mama ha dado lugar a nuevos dilemas clínicos en el manejo de pacientes con axila metastásica al diagnóstico. La linfadenectomía axilar es el estándar en su estadificación y tratamiento, pese a tasas de respuesta axilar completa de 40-60%. Estudios prospectivos recientes han demostrado una buena precisión de los métodos mínimamente invasivos de estadificación axilar, por lo que su práctica se está extendiendo entre grupos de expertos. Presentamos nuestros primeros resultados en la evaluación axilar postneoadyuvancia de pacientes con metástasis ganglionares al diagnóstico (cN1) mediante biopsia selectiva de ganglio centinela (BSGC) y disección axilar dirigida guiada con semilla de iodo-125

The expansion of neoadjuvant chemotherapy (NACT) in breast cancer has led to new clinical dilemmas in the management of node-positive cancers at diagnosis. Axillary lymphadenectomy is the standard approach for the staging and treatment, despite complete axillary response rates up to 40-60%. Recent prospective studies have shown good accuracy of non-invasive methods for axillary staging in cN1 patients post-NACT, and have led to the spreading of this practice among expert groups. The first results are presented with post-neoadjuvant axillary re-evaluation of cN1 patients using Sentinel Lymph node biopsy (SLNB) and targeted axillary dissection with iodine-125 seed

Roles of the multiplex real-time PCR assay and ß-D-glucan in a high-risk population for intra-abdominal candidiasis (IAC).

Multiplex quantitative real-time PCR (MRT-PCR) using blood can improve the diagnosis of intra-abdominal candidiasis (IAC). We prospectively studied 39 patients with suspected IAC in the absence of previous antifungal therapy. Blood cultures, MRT-PCR, and ß-D-glucan (BDG) in serum were performed in all patients. IAC was defined according to the 2013 European Consensus criteria. For MRT-PCR, the probes targeted the ITS1 or ITS2 regions of ribosomal DNA. Candidaemia was confirmed only in four patients (10%), and IAC criteria were present in 17 patients (43.6%). The sensitivity of MRT-PCR was 25% but increased to 63.6% (P = .06) in plasma obtained prior to volume overload and transfusion; specificity was above 85% in all cases. BDG performance was improved using a cutoff > 260 pg/ml, and improvement was not observed in samples obtained before transfusion. In this cohort of high risk of IAC and low rate of bloodstream infection, the performance of non-culture-based methods (MRT-PCR or BDG) was moderate but may be a complementary tool given the limitations of diagnostic methods available in clinical practice. Volume overload requirements, in combination with other factors, decrease the accuracy of MRT-PCR in patients with IAC.

La técnica Delphi para el rediseño y validación de un instrumento que mide la comunicación enfermera-paciente / Using the Delphi method to redesign and validate an instrument measuring nurse-patient communication / A técnica Delphi para o redesenho e validação de um instrumento que mede a comunicação enfermeira-paciente

Resumen Introducción: La evaluación de la comunicación entre la enfermera y el paciente da cuenta de la dimensión interpersonal en la calidad del cuidado. Esta relación ha sido estudiada desde diversos enfoques con énfasis en algunos aspectos, como el diseño y validación de instrumentos. Objetivo: Rediseño y validación de contenido de un instrumento que mide comunicación enfermera-paciente, con base en la técnica Delphi. Metodología: Se enfoca al rediseño y validación de un instrumento, con la aplicación de la técnica Delphi, con la participación de enfermeras expertas, sensibles a la relación terapéutica; se realizaron tres rondas con integración de contenidos por las coordinadoras y la aplicación de los coeficientes de validación de contenido por reactivo (CVR) y validación de contenido integral (CVI). Resultados: El CVI del instrumento en cuestión (CECOP-23) en la primera ronda fue 0.84, posterior a ello se eliminaron cuatro reactivos y se sustituyeron dos que fueron sugeridos por los expertos. En la segunda ronda el instrumento alcanzó un CVI de 0.95, el grupo sugirió la utilización de términos más sencillos que propiciaran la cercanía con el paciente. En la tercera ronda se obtuvo un CVI de 0.96. El CECOP quedó integrado por 21 reactivos, diez que exploran empatía y once que exploran respeto. Conclusiones: El trabajo con los expertos permitió analizar los reactivos del CECOP-23, obteniendo el CECOP-21, con reactivos de mayor calidez y exploración más precisa, cumpliendo con el objetivo de diseñar un instrumento que explore ambas dimensiones manteniendo el equilibrio entre la empatía y el respeto.

Abstract Introduction: The assessment of the communication between nurses and patients is part of the interpersonal dimension of quality of care. This relationship has been studied from diverse points of view which focus on issues such as the design and validation of measuring instruments. Objective: Using the Delphi method, to redesign and validate a nurse-patient communication measuring instrument. Methodology: Together with expert and sensitive to the therapeutic relationship nurses, the Delphi method was used to redesign and validate a communication measuring instrument. The coordinators assessed the contents in three cycles calculating the Item Content Validity and Integral Content Validity coefficients. Results: The Integral Content Validity of the CECOP-23 instrument was 0.84 in the first cycle. Four items were deleted and two were substituted in agreement with the suggestions of the experts. The Integral Content Validity of the instrument was 0.95 in the second cycle. The group suggested using simpler terms which could foster closeness to the patient. The Integral Content Validity was 0.96 in the third cycle. The CECOP instrument was finally constituted by 21 items, 10 exploring empathy and 11 exploring respect. Conclusions: Working along with the experts prompted the analysis of the CECOP-23 instrument in order to produce the CECOP-21 which has more precise and "warm" items. The objective of redesigning and instrument which, maintaining the equilibrium between empathy and respect, could measure the nurse-patient communication was achieved.

Resumo Introdução: A avaliação da comunicação entre a enfermeira e o paciente dá conta da dimensão interpessoal na qualidade do cuidado. Esta relação tem sido estudada desde diversos enfoques com ênfase em alguns aspectos, como o desenho e a validação de instrumentos. Objetivo: redesenho e validação de conteúdo de um instrumento que meça a comunicação enfermeira-paciente, com base na técnica Delphi. Metodologia: Foca-se no redesenho e validação de um instrumento, com a aplicação da técnica Delphi, com a participação de enfermeiras experientes, sensíveis à relação terapêutica; realizaram-se três ciclos com integração de conteúdos pelas coordenadoras e a aplicação dos coeficientes de validação de conteúdo por item (CVR) e a validação de conteúdo integral (CVI). Resultados: O CVI do instrumento em questão (CECOP-23) na primeira volta foi 0.84, posterior a isto, eliminaram-se quatro itens e substituíram-se dois que foram sugeridos pelos especialistas. Na segunda volta o instrumento atingiu um CVI de 0.95, o grupo sugeriu a utilização de termos mais simples que propiciaram a proximidade com o paciente. Na terceira volta obteve-se um CVI de 0.96. O CECOP ficou integrado por 21 itens, dez que exploram empatia e onze respeito. Conclusões: O trabalho com os especialistas permitiu analisar os itens de CECOP-23, obtendo o CECOP-21, com itens de maior qualidade e exploração mais precisa, cumprindo com o objetivo de desenhar um instrumento que explore ambas as dimensões mantendo o equilíbrio entre a empatia e o respeito.

Complicaciones postoperatorias en mujeres con cirugía por cáncer de mama / Postoperative complications among women with breast cancer surgery / Complicações pós-operatórias em mulheres com cirurgia para câncer de mama

Resumen Introducción: El cáncer de mama es una enfermedad crónica degenerativa, por su naturaleza, requiere que la mujer reciba tratamiento multimodal como la cirugía para su control, exponiéndola a numerosos riesgos que la llevan a presentar complicaciones postoperatorias. Objetivo: Identificar la prevalencia de complicaciones postoperatorias que presentan las mujeres con cáncer de mama en una institución de salud de tercer nivel de atención. Material y métodos: Estudio observacional, transversal, retrolectivo. La unidad de análisis fueron los expedientes de mujeres a quienes se les realizó cirugía en el año 2015. La muestra fue a conveniencia con la revisión de 52 casos. Para la recolección de datos se elaboró una cédula y se procesó la información con el paquete estadístico SPSS v.24. Resultados: El 42% de las mujeres presentaron alguna complicación quirúrgica: dehiscencia de herida con un 27%, seguido de infección y dolor con 23% cada una, estas se manifestaron entre los 40 días posteriores al egreso del hospital; linfedema con 23% y 4% por seroma, ambas se presentaron generalmente después de cuatro meses. Discusión: Se ha evidenciado que las complicaciones derivadas del tratamiento quirúrgico del cáncer de mama tienen una prevalencia del 42%, superior a lo reportado en otros estudios donde la proporción va de 25 al 32%. Conclusiones: Las complicaciones postoperatorias en su mayoría son esperadas y prevenibles, por ello, es necesario que los profesionales de la salud propongan estrategias para su prevención o detección temprana, a través de la identificación de factores de riesgo modificables reportados en la literatura.

Abstract Introduction: Breast cancer is a degenerative chronic illness which forces women to go through diverse treatments which often include surgery and its related postoperatory complications. Objective: To identify the prevalence of postoperatory complications among women with breast cancer treated in a tertiary healthcare institution. Methods and Materials: This is an observational, transversal, and retrolective. The units of analysis were the records on women who underwent breast cancer related surgery in the year 2015. The convenience sample included 52 corresponding cases. Data were collected through a specific form and processed with SPSS v.24. Results: 42% of women showed some type of surgical complication. From these, 27% suffered wound dehiscences, 23% pain, and 23% infections. These complications appeared within 40 days after being discharged. Also, 23% suffered lymphedema, and 4% seroma, after 4 months of the surgery. Discussion: A 25% to 42% prevalence of complications derived from breast cancer surgical treatments has been evidenced. Conclusions: Postoperatory complications are expected, but also preventable. Because of this, it is necessary that health professionals develop strategies aimed at addressing this situation by identifying the modifiable risk factors.

Resumo Introdução: O câncer de mama é uma doença crônica degenerativa, por sua natureza, requer que a mulher receba tratamento multimodal como a cirurgia para seu controle, expondo-a a numerosos riscos que a levam a apresentar complicações pós-operatórias. Objetivo: Identificar a prevalência de complicações pós-operatórias que apresentam as mulheres com câncer de mama em uma instituição de saúde de terceiro nível de atenção. Material e métodos: Estudo observacional, transversal, retroletivo. A unidade de análise foram os expedientes de mulheres a quem se lhes realizou cirurgia no ano 2015. A amostra foi a conveniência com a revisão de 52 casos. Para a recolha de dados elaborou-se uma carteira e processou-se a informação com o paquete estatístico SPSS v.24. Resultados: O 42% das mulheres apresentaram alguma complicação cirúrgica: deiscência de ferida com um 27%, seguido de infecção e dor com 23% cada uma, estas se manifestaram entre os 40 dias posteriores ao egresso do hospital; linfedema com 23% e 4% por seroma, ambas se apresentaram geralmente depois de quatro meses. Discussão: Tem se evidenciado que as complicações derivadas do tratamento cirúrgico do câncer de mama têm uma prevalência do 42%, superior ao informado em outros estudos onde a proporção vai de 25 ao 32%. Conclusões: As complicações pós-operatórias em sua maioria são esperadas e evitáveis, por isso, é necessário que os profissionais da saúde proponham estratégias para sua prevenção ou detecção precoce, através da identificação de fatores de risco modificáveis informados na literatura.

Eventos adversos en pacientes hospitalizados reportados por enfermería: un estudio multicéntrico en México / Nursing reported hospitalized patients adverse events: A multi-centric study in Mexico / Eventos adversos em pacientes hospitalizados relatados por enfermagem: um estudo multicéntrico no México

Introducción: Los eventos adversos (EA) son un daño no intencionado derivado de la atención sanitaria que se relacionan con los recursos humanos, los factores del sistema o las condiciones clínicas del paciente. Objetivo: Analizar factores relacionados con la calidad y la seguridad del paciente a través de los reportes de EA. Metodología: Diseño transversal, multicéntrico, realizado en 5 institutos nacionales de salud y en un hospital de alta especialidad, se estudiaron los EA ocurridos durante 18 meses, para lo cual se utilizó el instrumento SYREC 2007; análisis descriptivo y evaluación de asociación entre grado de evitabilidad y factores intrínsecos, extrínsecos y del sistema; se observaron los aspectos éticos vigentes. Resultados: Se analizaron un total de 540 EA, ocurrieron 55.5% en hombres, 58.7% estaban en estado de alerta, el 92.6% de los EA ocurrió en el servicio asignado, el 55.9% no se reportó a la familia, se consideró sin duda como evitable en el 70.5%, los factores del sistema estuvieron presentes en 80.6%, hubo asociación significativa entre estos y la evitabilidad del suceso. Discusión: Los principales resultados encontrados son coincidentes con otras investigaciones internacionales tales como: To err is human 1999, el estudio ENEAS de España 2006 y con el de prevalencia IBEAS 2010; en todos ellos se hizo evidente la necesidad de reforzar la cultura de la notificación de los EA y el clima para la seguridad del paciente, además de promover una reflexión interpersonal acerca de la calidad de los servicios asistenciales. Conclusiones: Los factores relacionados con el sistema tienen un mayor peso en la aparición de EA. Es de vital importancia su identificación a fin de poder evitarlos.

Introduction: Adverse events (AE) are unintended harms derived from human health attention, system factors, or clinical conditions in the patients. Objective: To analyze factors influencing the quality of patient healthcare and safety through the review of diverse records on AEs. Methodology: This transversal and multi-centric design study was carried out in five National Institutes of Health and a high specialty hospital. AEs in an 18 month period were studied using the SYREC 2007 instrument. Descriptive analysis, as well as assessments on the association between the preventability degree and the intrinsic, extrinsic, and system factors were all performed. Current ethical issues were observed. Results: A total of 540 AEs were analyzed; 55.5% occurred in men; 58.7% occurred during state of alertness; 92.6% occurred at the assigned service; 55.9% were not reported to the families; 70.5% were considered preventable; and system factors were present in 80.6% of them. A significant association between the AEs and the possibility to prevent them was found. Discussion: The main findings were consistent with those of other international studies including: ''To err is human'', 1999, the ENEAS study in Spain, 2006, and the IBEAS prevalence study, 2010. All of these studies emphasize the need to strengthen the culture of AE-notifying and to improve the patient safety climate, as well as to promote inter-personal reflections on to the quality of care services. Conclusions: System-related factors have the strongest influence on the occurrence of AEs, and thus, their identification becomes critical in order to enhance the quality of healthcare services.

Introdução: Os Eventos Adversos (EA) são um dano não intencionado derivado da atenção sanitária que se relaciona com os recursos humanos, os fatores do sistema ou as condições clínicas do paciente. Objetivo: Analisar fatores relacionados com a qualidade e a segurança do paciente a través dos relatórios de EA. Metodologia: Desenho transversal, multicéntrico, realizado em cinco Institutos Nacionais de Saúde e um hospital de alta especialidade, estudaram-se os EA ocorridos durante 18 meses, para o qual se utilizou o instrumento SYREC 2007; análise descritiva e avaliação de associação entre grau de evitabilidade e fatores intrínsecos, extrínsecos e do sistema; observaram-se os aspectos éticos vigentes. Resultados: Analisaram-se um total de 540 EA, ocorreram 55.5% em homens, 58.7% estavam em estado de alerta, o 92.6% o EA aconteceu no serviço assignado, o 55.9% não se informou à família, considerou-se sem dúvida como evitável no 70.5%, os fatores do sistema estiveram presentes em 80.6%, houve associação significativa entre estes e a evitabilidade do evento. Discussão: Os principais resultados encontrados são coincidentes com outras pesquisas internacionais tais como: ''To err is human'' 1999, o estudo ENEAS da Espanha 2006 e com o de prevalência IBEAS 2010; em todos eles se fez evidente a necessidade de reforçar a cultura da notificação dos EA e o clima para a segurança do paciente, além de promover una reflexão interpessoal acerca da qualidade dos serviços assistenciais. Conclusões: Os fatores relacionados com o sistema têm um maior peso na aparição de EA. É de vital importância sua identificação a fim de poder evitá-los.

Comparison of planar bone scintigraphy and single photon emission computed tomography for diagnosis of active condylar hyperplasia.

PURPOSE: The aim of this study was to compare the reliability and correlations with age and gender of two nuclear medicine tests used for diagnosis of active condylar hyperplasia, namely, planar bone scintigraphy versus single photon emission computed tomography (SPECT). MATERIAL AND METHOD: This was a descriptive observational study carried out in 61 patients (38 women and 23 men) clinically diagnosed as having facial asymmetry and suspected unilateral condylar hyperplasia. The patients had both planar bone scintigraphy and SPECT diagnostic imaging as well as reference data of the percentage of (99)Tc(m) MDP (methylenediphosphonate) uptake in the condyle, clivus, and fourth lumbar vertebra (L4), respectively, for SPECT and planar scintigraphy calculations. Radioactive counts were measured per region of interest and the respective ratios were calculated. The age range of the patients was 13-50 years (mean ± standard deviation = 21.16 ± 8.75). The two groups were compared by a nonparametric (Mann-Whitney U test. Uptake percentage and delta values had normal distribution and consequently were compared by a Student t test. RESULTS: A total of 61 anterior planar images and 61 SPECT images were compared. Eight patients presented high uptake in planar bone scintigraphy images (13.11%), while 32 patients (52.46%) had high uptake with SPECT. The prevalence of condylar hyperactivity was higher in women than in men both for right condyle (ratio 4:3) and for left condyle (10:1) and the prevalence was significantly higher for the right condyle. CONCLUSION: The study indicates that SPECT is more sensitive to identify condylar hyperactivity as compared to planar bone scintigraphy in patients with clinical presumptive diagnostic of condylar hyperplasia.

Hiperplasia condilar: características, manifestaciones, diagnóstico y tratamiento. Revisión de tema / Condylar hyperplasia: characteristics, manifestations, diagnosis and treatment. A topic review

La hiperplasia condilar es una patología que no solo afecta las proporciones y la simetría facial en los pacientes, sino que también afecta la función estática y dinámica de la oclusión con repercusiones en la actividad masticatoria, la salud de la articulación temporomandibular (ATM) y la anatomía y volumen de los tejidos blandos adyacentes. Por lo tanto, es una entidad que, según su severidad, compete a cirujanos maxilofaciales, ortodoncistas, fisioterapeutas, cirujanos plásticos y médicos nucleares, quienes están muy relacionados en la etapa de diagnóstico. Históricamente, el diagnóstico de hiperplasia condilar se ha basado en la anamnesis y el examen físico inicial del paciente, en donde se detectan la asimetría, la maloclusión y en algunos casos desórdenes temporomandibulares (DTM), que luego son corroborados con exámenes como la gammagrafía ósea y, finalmente, por el informe de patología después de que la cirugía condilar se ha realizado. El propósito de esta revisión bibliográfica, es conocer de manera detallada el comportamiento de esta patología desde el punto de vista de su etiología, sus características clínicas, su distribución por edad, sexo y cóndilo afectado, así como las ayudas diagnósticas e imagenológicas necesarias para su diagnóstico, las enfermedades asociadas y su diagnóstico diferencial, las características histológicas del tejido afectado y sus diferentes abordajes terapéuticos según la severidad, la edad del paciente y la patología en su forma activa o inactiva. La información se obtuvo de artículos de investigación científica, publicados en diferentes revistas y revisiones de la literatura, tomados de bases de datos como MEDLlNE, EMBASE y PubMed.

Condylar hyperplasia is a condition that affects not only the proportions and facial symmetry in patients, but also static and dynamic occlusion functions with repercussions in the masticatory activity, the health of the temporomandibular joint (TMJ), and the anatomy and volume of adjacent soft tissues. Therefore, according to its severity this disease concerns maxillofacial surgeons, orthodontists, physical therapists, plastic surgeons, and nuclear doctors, who are all closely involved in the diagnosis stage. Historically, diagnosis of condylar hyperplasia has been based on anamnesis and the initial physical examination of the patient, where asymmetry, malocclusion and in some cases temporomandibular disorders (TMDs) are detected and later confirmed with tests such as bone scan and eventually by pathology report once condylar surgery has been done. The purpose of this literature review is to provide detailed information on the behavior of this disease from the point of view of its etiology, clinical characteristics, and distribution by age, sex and affected condyle, as well as the necessary diagnostic and imaging aids for its diagnosis, differential diagnosis, associated diseases, histological characteristics of the affected tissues, and the different therapeutic approaches according to severity, patient's age, and active or inactive form of the condition. The information was obtained from scientific research articles in different journals and literature reviews, taken from databases such as MEDLINE, EMBASE, and PubMed.

Factores relacionados con eventos adversos reportados por enfermería en unidades de cuidados intensivos. Proyecto multicéntrico / Factors related to nursing-reported adverse events in intensive care units: Multicenter project / Fatores relacionados com a presença de eventos adversos informados pela enfermagem na unidade de cuidados intensivos. Projeto multicêntrico

La atención a la salud a veces puede representar un riesgo para los pacientes, que puede derivar en daño físico, psicológico, social, económico, e incluso la muerte. Estos incidentes se denominan eventos adversos (EA) y se presentan durante el proceso de atención. Objetivo: Determinar la ocurrencia de los EA en las áreas de cuidados intensivos y conocer los factores intrínsecos, extrínsecos y del sistema que están presentes en la aparición de un EA, así como su evitabilidad y gravedad. Métodos: Estudio multicéntrico, analítico, transversal y observacional, en siete instituciones de salud de carácter público y de alta especialidad en México. La muestra estuvo compuesta por 137 personas durante el periodo comprendido del 1-04-2012 al 31-01-2013. Los datos se recolectaron con la ficha de notificación de EA tomada y adaptada del proyecto SYREC 2007. Se utilizó el programa estadístico SPSS versión 17. Se realizaron pruebas de correlación de Spearman y phi, U de Mann-Witney, Kruskal-Wallis y Chi2. Resultados: El 58% de los EA se presentaron en pacientes masculinos, el 60% en edad pediátrica. Los EA relacionados con el cuidado fueron los más frecuentes con un 29.9%. En el 51% estuvieron relacionados con invalidez temporal. En un 75% de los casos se pudieron evitar. Sobresalen los factores del sistema con un 98%.Conclusiones: La población más vulnerable son los niños y los adultos mayores, los EA están relacionados directamente con el cuidado de enfermería y su mayoría son evitables. Es necesario implementar estrategias para la gestión de la seguridad del paciente para detectar, registrar, prevenir y minimizar su frecuencia.

Health treatment can sometimes involve risk for patients, which can result in physical, psychological, social, or financial damage, and even death. These incidents are called adverse events (AE) and occur during the treatment process.ObjectiveTo determine the occurrence of AE in intensive care areas, and identify the intrinsic, extrinsic, and systemic factors involved in an AE, and to assess their severity and how to avoid them. Methods Multi-centric, analytic, transversal, and observational study conducted on 7 public and high specialty health institutions in Mexico with a sample of 137 individuals. The study was carried out from 04/01/2012 to 01/31/2013. Data were collected through SYREC 2007 project adapted AE notification charts. SPSS version 17 was used. Spearman, Phi, Mann-Whitney U, Kruskal-Wallis and Chi2 tests were performed. Results:58% of AE occurred among male patients, 60% among the pediatric population. The most frequent AE were those related to care (29.9%). 51% were related to temporal disability. 75% of the cases could not be avoided. Systemic factors were the prevalent ones with 98%. Conclusions: The most vulnerable populations are children and the elderly. AE are directly related to nursing care and most are avoidable. It is necessary to implement strategies to manage patient safety in order to detect, register, prevent, and minimize the frequency of AE.

A atenção à saúde representa em vários momentos um risco para os pacientes, que pode derivar em dano físico, psicológico, social, económico, inclusivé a morte. Estes incidentes denominam-se eventos adversos (EA), apresentam-se durante o processo de atenção. Objetivo Determinar a ocorrência dos EA nas áreas de cuidados intensivos e conhecer fatores intrínsecos, extrínsecos e do sistema que estão presentes no aparecimento de um EA, bem como a possibilidade de evita-los e a sua gravidade. Métodos: Estudo multicêntrico, analítico, transversal e observacional, em 7 instituições de saúde pública e de alta especialidade no México. A amostra foi de (n = 137) durante o periodo compreendido entre 01-04-2012 e 31-01-2013. Os dados foram recolhidos com a ficha de notificação de EA tomada e adaptada do projeto SYREC 2007. Utilizou-se o programa estatístico SPSS versão 17. Realizaram-se testes de correlação de Spearman e Phi, U de Mann-Witney, Kruskal-Wallis e Chi2. Resultados: Os 58% dos EA apresentaram-se nos pacientes masculinos, os 60% na idade pediátrica. Os EA mais frequentes foram relacionados com o cuidado, com 29.9%. 51% estiveram relacionados com incapacidade temporária. Em 75% dos casos pôde-se evitar. Sobressaem os fatores do sistema com 98%. Conclusões: A população mais vulnerável são as crianças e os idosos, os EA relacionam-se diretamente com o cuidado da enfermagem e a sua maioria são evitáveis. É necessário implementar estratégias para a gestão da segurança do paciente para detectar, registrar, prevenir e minimizar a sua frequência.

Melatonin in the oral cavity: physiological and pathological implications.

BACKGROUND AND OBJECTIVES: The purpose of this article was to summarize what is known about the function of melatonin in the oral cavity. MATERIAL AND METHODS: Databases were searched for the relevant published literature to 30 November, 2013. The following search items were used in various combinations: melatonin, gingiva, periodontium, inflammation, herpes, alveolar bone, periodontal ligament, dental implants, xerostomia, methacrylate, chlorhexidine, cancer. The literature uncovered is summarized herein. RESULTS: Salivary melatonin levels exhibit a circadian rhythm with highest values at night. Melatonin has both receptor-mediated and receptor-independent actions in cells of the oral cavity. Melatonin is released into the saliva by the acinar cells of the major salivary glands and via the gingival fluid. Functions of melatonin in the oral cavity are likely to relate primarily to its anti-inflammatory and antioxidant activities. These actions may suppress inflammation of the gingiva and periodontium, reduce alveolar bone loss, abrogate herpes lesions, enhance osteointegration of dental implants, limit oral cancer, and suppress disorders that have a free radical component. Sublingual melatonin tablets or oral melatonin sprays and topical melatonin-containing gel, if used on a regular basis, may improve overall oral health and reduce mucosal lesions. CONCLUSION: Collectively, the results indicate that endogenously-produced and exogenously-applied melatonin are beneficial to the oral cavity.

Intervenciones de enfermería especializada en un adulto con alteraciones de la marcha ocasionadas por quemadura eléctrica / Specialized nursing interventions in an adult with gait alterations as a result of electrical burn

Introducción: El programa de rehabilitación del paciente quemado se centra en 4 áreas: actividades de la vida diaria, arcos de movimiento, posicionamiento y manejo de la cicatrización, encaminadas a limitar la pérdida de movimiento, minimizar deformaciones anatómicas y reintegrar al paciente a la vida social. Objetivo: Proporcionar cuidado especializado de enfermería a paciente quemado. Métodos: Se trata de masculino de 55 años con quemaduras de tercer grado por electricidad en ambas manos y en el primer ortejo derecho. Se realizó una valoración integral de enfermería, utilizando una guía de entrevista, seguida de una exploración física. Se complementó con otras herramientas de valoración como: índice de Barthel, escala de Lawton, Tinetti, Daniels y Crichton. Los diagnósticos de enfermería se formularon utilizando el formato P.E.S. Resultados: Se identificó como problema principal la movilidad, específicamente la marcha así como el manejo de la cicatriz. Conclusiones: Se aumentó la fuerza y el tono de los músculos cuádriceps e isquiotibiales y, se disminuyó la retracción y la hiperestesia de la cicatriz del primer ortejo derecho.

Introduction: The burned patient rehabilitation program is centered on four areas: daily life activities, movement arches, positioning, and wound healing management, all directed to limit movement loss, minimize anatomical deformations, and reintegrate the patient into his/her social life. Objective: To provide specialized nursing care to the burned patient. Methods: The patient is a 55 year old male with 3rd degree electricity burns in both hands and the first right digit. An integral nursing assessment was performed using a survey guide, followed by a physical exploration, and other assessment tools including the Barthel Index, the Lawton scale, Tinetti, Daniels and Crichton. Nursing diagnoses were generated using the P.E.S. format. Results: Mobility, gait, and wound healing were identified as core problems. Conclusions: Quadriceps and hamstring muscles strength and tone were enhanced, the first right digit wound hyperesthesia and retractions were diminished.

Desarrollo y evolución de la Investigación en Enfermería a través del trabajo en Red: La experiencia de 2 Institutos Nacionales de Salud / Development and evolution of Nursing Research through teamwork: The experience of two National Institutes of Health

Los profesionales de Enfermería reconocen que la investigación en esta disciplina, inicia con los registros detallados de las observaciones de Florencia Nightingale, quien aplicó sus conocimientos de historia y filosofía al estudio del entorno, lo que le permitió definir el cuidado como eje de su actuación e ideología de vida; plasmó la lógica del pensamiento y actuar de Enfermería, y sentó las bases filosóficas, epistemológicas y éticas a partir del análisis del contexto histórico sociocultural en el cual desarrolló su principal obra; todo a partir de una bitácora con sus notas, que ha servido de referencia para el desarrollo de las actuales teorías de Enfermería. Para el caso de nuestro país, en los últimos años las Instituciones donde se desarrollan los profesionales de Enfermería en un esfuerzo conjunto han tratado de insertar e impulsar unidades destinadas a la investigación de Enferme- ría, siempre con el objetivo de la reflexión sobre el cuidado desde diferentes ángulos, miradas o aproximaciones para de esta manera obtener resultados propositivos, intervenir oportunamente y ser competitivos en los diferentes niveles de atención de manera interdisciplinar en el campo de la práctica clínica, la gestión y la enseñanza.

Intervenciones de enfermería en rehabilitación a una persona con prótesis de cadera por tumor de células gigantes / Nursing rehabilitation interventions on a patient with hip prothesis as consequence of a giant cell tumor

La asistencia de enfermería en rehabilitación tiene como principales objetivos ayudar al paciente a alcanzar su máxima independencia de acuerdo a sus capacidades, promover el autocuidado a través de orientación y entrenamiento de situaciones que le permitan reinsertarse a su vida social y familiar de la mejor manera posible y con calidad. Es por ello que en los pacientes con prótesis total de cadera, enfermería desempeña un papel importante para lograr la autonomía en las actividades de la vida diaria (AVD). Objetivo: Dar a conocer el papel del profesional de enfermería especialista en rehabilitación en la atención de pacientes con prótesis de cadera. Metodología: El caso seleccionado corresponde a una persona con prótesis total de cadera por tumor de células gigantes; la valoración se realizó mediante interrogatorio utilizando una guía de entrevista, se complementó con la exploración física y la aplicación de escalas de: Daniels, Tinetti, Lawton, Barthel y la Escala Visual Análoga. Los diagnósticos de enfermería se realizaron con el formato PES, y se propusieron intervenciones especializadas en rehabilitación. Resultados: El problema principal fue el deterioro de la movilidad física de la cadera izquierda; por lo cual se realizaron intervenciones como aplicación de termoterapia, movimiento articular, ejercicios de fortalecimiento, ejercicios de equilibrio, ejercicios para la marcha, utilización de dispositivos para la marcha, entre otros. Como resultado de las intervenciones de enfermería en rehabilitación se incrementó la fuerza muscular que repercutió directamente en la marcha y en la realización de las actividades de la vida diaria.

Nursing assistance in rehabilitation has as principal objectives to help the patient reach his/her maximum independence according to his/her capabilities, to promote the self-care through orientation and training of situations that allow him/ her re-integrate to his/her social and familial lives in the best possible form and with quality. Because of that in patients with total hip prothesis nursing has an important paper to achieve autonomy in the activities of the daily life (ADL). Objective: to show the role of the professional of nursing with specialization in rehabilitation of patients with hip prothesis. Methodology: the selected case corresponds to a person with total hip prothesis because of a giant cells tumor; the assessment was performed through an interview using a guide, this was completed with the physical exploration and the use of the scales of: Daniels, Tinetti, Lawton, Barthel and the Visual Analogous. Nursing diagnostics were performed with the PES format, and interventions specialized in rehabilitation were proposed. Results: The principal problem was the impairment of the physical mobility of the left hip; and because of this, interventions such as applying of thermotherapy, joint movement, strengthening exercises, equilibrium exercises, gait exercises, use of gait devices, among others. As a result of the interventions of nursing in rehabilitation muscle strength augmented which directly influenced in the gait and in the daily life activities.

The photoperiod, circadian regulation and chronodisruption: the requisite interplay between the suprachiasmatic nuclei and the pineal and gut melatonin.

The current scientific literature is replete with investigations providing information on the molecular mechanisms governing the regulation of circadian rhythms by neurons in the suprachiasmatic nucleus (SCN), the master circadian generator. Virtually every function in an organism changes in a highly regular manner during every 24-hour period. These rhythms are believed to be a consequence of the SCN, via neural and humoral means, regulating the intrinsic clocks that perhaps all cells in organisms possess. These rhythms optimize the functions of cells and thereby prevent or lower the incidence of pathologies. Since these cyclic events are essential for improved cellular physiology, it is imperative that the SCN provide the peripheral cellular oscillators with the appropriate time cues. Inasmuch as the 24-hour light:dark cycle is a primary input to the central circadian clock, it is obvious that disturbances in the photoperiodic environment, e.g., light exposure at night, would cause disruption in the function of the SCN which would then pass this inappropriate information to cells in the periphery. One circadian rhythm that transfers time of day information to the organism is the melatonin cycle which is always at low levels in the blood during the day and at high levels during darkness. With light exposure at night the amount of melatonin produced is compromised and this important rhythm is disturbed. Another important source of melatonin is the gastrointestinal tract (GIT) that also influences the circulating melatonin is the generation of this hormone by the entero-endocrine (EE) cells in the gut following ingestion of tryptophan-containing meal. The consequences of the altered melatonin cycle with the chronodisruption as well as the alterations of GIT melatonin that have been linked to a variety of pathologies, including those of the gastrointestinal tract.

Nivel de cumplimiento de la Norma Oficial Mexicana 168-SSA1-1998. Una perspectiva del profesional de Enfermería / Level of fulfillment of the Mexican Health Standard NOM 168-SSA1-1998. A perspective from the Nursing Professional

Introducción: Los registros que realiza el profesional de enfermería son el soporte de los cuidados que brinda a cada una de las personas que le son asignadas en su jornada laboral, además son un elemento primordial para la toma de decisiones en la gestión del cuidado; por lo tanto es importante que los registros se realicen dando cumplimiento a la NOM 168-SSA1-1998 del expediente clínico para favorecer la continuidad y seguridad del cuidado; por lo cual el objetivo del estudio fue comparar el nivel de cumplimiento de la NOM 168-SSA1.1998 del expediente clínico en dos Institutos Nacionales de Salud, desde la perspectiva del profesional de enfermería. Material y métodos: Se realizó un estudio transversal, observacional, descriptivo y comparativo, la muestra estuvo integrada por 186 enfermeras. El nivel de cumplimiento de la NOM 168-SSA1-1998 se midió con una escala tipo likert modificado con 5 opciones de respuesta; para el análisis de datos se utilizó estadística descriptiva e inferencial. Resultados: Los datos obtenidos mostraron que la mayoría de las enfermeras refieren utilizar en sus registros lenguaje técnico, abreviaturas universales y letra legible, evitan realizar tachaduras y enmendaduras. Se observaron diferencias entre los dos institutos con relación al nivel de cumplimiento de la NOM 168-SSA1-1998 con un valor de p< 0.05. Conclusiones: Desde el punto de vista de las enfermeras el nivel de cumplimiento en la norma es adecuado lo cual puede limitar su disposición para participar en programas de mejora.

Introduction: Mexican nursing professionals back up their care interventions through registers, and this information becomes fundamental in the process of decision-making. Therefore, in order to promote care continuity and security, it is important that these registers fulfill the Mexican health standard NOM 168- SSA1-1998. The objective of this study was to compare the levels of fulfillment of this standard in two National Institutes of Health. Methods and material: A basic, observational, and comparative study was conducted with a sample of 186 nurses. The level of standard fulfillment was estimated using a 5 point Likert Scale. Descriptive and inferential statistics were performed. Results: our findings suggest that the majority of nurses use technical language with legible and neat writing. A difference was found between the two institutes (p < .05). Conclusions: from the perspective of these nurses, the level of fulfillment of this standard was adequate.

Quadriplegia recovery after hemi-section and transplant model of spinal cord at the level of C5 and C6.

A spinal cord hemi-section with a homologous transplant of medullar tissue at the level of C5-C6 and preservation of the anterior spinal artery was used to evaluate the histological characteristics such as quantity and quality of axons, myelin index and blood vessels after quadriplegia recovery. Vascular changes after spinal injury results in severe endothelial damage, axonal edema, neuronal necrosis and demyelinization as well as cysts and infarction. Preservation of the anterior spinal artery has demonstrated clinical recuperation; therefore, in addition to the lesion we included a homologous transplant to visualize changes at a cellular level. Two groups of dogs (hemi-section and transplant) went through a traumatic spinal cord hemi-section of 50% at the level of C5-C6. The transplant group formed by animals which simultaneously had 4 mm of spinal cord removed and the equal amount substituted from a donor animal at the level of C5-C6 corresponding to the half right side; both preserving the anterior spinal artery. Histological evaluation of all groups took place at days 3 (acute) and 28 (chronic) post-operation. Changes of degeneration and axonal regeneration were found in the hemi-section and transplant groups at acute and chronic time, as well as same quadriplegia recovery at chronic time in the hemi-section and transplant groups which closely related to mechanisms which participate in regeneration and functional recuperation due to the preservation of the anterior spinal artery and presence of new blood vessels.

Fístula periareolar recidivante: técnica del setón / No disponible

La fístula periareolar recidivante de mama es una patología infrecuente, caracterizada por abscesos de repetición en la zona periareolar, con crisis de retención y de fistulización. El uso de la técnica del setón, empleada en el tratamiento de las fístulas anales, facilita el manejo de esta patología, evitando los abscesos de repetición y mejorando la calidad de vida de las pacientes. Al mismo tiempo, permite programar la cirugía electiva manteniendo tutorizado el trayecto fistuloso y minimizando la cantidad de tejido a extirpar(AU)

A breast fistula is an uncommon disease, characterized by subareolar breast abscess with episodes of retention and fistulization. The seton technique, well known in the treatment of anal fistula, is useful in the management of breast fistula, helping to avoid the risk of iterative abscess and improving the quality of life of these patients. Furthermore, it allows the programming of the elective surgery keeping tutorized the fistulous tract, reducing the amount of tissue needed to be removed(AU)

Neurosonografía y resonancia magnética en patología cerebral fetal severa / Ultrasound and magnetic resonance imaging in the prenatal evaluation of brain pathology

Abnormalities of the brain are among the most frequent congenital malformations and its incidence is probably higher than reported as many of the anomalies are only recognized postnatally. Fetal neurosonography performed transvaginally has become an important imaging technique based on its improved resolution and resulting better sensibility. Nevertheless, there are several maternal and fetal factors that can affect visualization rate and, therefore, it has been recommended that US should be complemented with 3D ultrasound and magnetic resonance imaging (MRI) in the prenatal evaluation of brain pathology. In the last years, the incorporation of ultrafast MRI has allowed to obtain high-quality images from the fetal lungs and brain. In this collaborative work from 2 public hospitals, we compare the diagnostic performance of fetal neurosonography and MRI in 17 cases of severe fetal brain abnormalities. MRI was able to confirm the diagnosis in 100 percent of the cases, adding important clinical information in 17 percent, although missed diagnoses were documented in 12 percent of them. These results are comparable to other published series, highlighting the diagnostic correlation between the 2 techniques. Nevertheless, ultrasound has the advantages of its wider availability and lower costs than MRI, which make it the prefered imaging modality when a fetal brain malformation is suspected.

Las malformaciones congénitas cerebrales son muy frecuentes y probablemente tengan una incidencia mayor aun a la descrita, pues muchas de ellas solo son reconocidas en la etapa postnatal. La neurosonografía fetal dirigida por vía transvaginal se ha incorporado los últimos años como el estándar de referencia en el diagnostico de estas malformaciones, especialmente por la mayor sensibilidad y una mejor resolución. Aun así, pueden existir condiciones maternas o fetales que obligan a complementar el estudio con otras tecnologías como el ultrasonido 3D y la resonancia magnética (RM). Con la incorporación de secuencias ultrarrápidas, la RM ha permitido obtener imágenes prenatales de calidad diagnostica donde destacan el estudio de malformaciones de tórax y del cerebro fetal. Este trabajo colaborativo de 2 centros públicos compara los resultados diagnósticos entre la neurosonografía y RM en 17 casos de patología neurológica fetal. La RM confirma el 100 por ciento de los diagnósticos, pero además entrega información adicional en un 17 por ciento pero omite información parcial en un 12 por ciento de los casos. Estos resultados son comparables a lo publicado en series extranjeras, destacando la alta correlación diagnostica entre los 2 métodos. Sin embargo, los beneficios que tiene el US en comparación con la RM, como la alta disponibilidad y el bajo costo, aconsejan su uso preferente en nuestro medio.

Intervención educativa de enfermería para la rehabilitación de personas con una ostomia / Educative intervention of nursering in the rehabilitation of an ostomized person

Introducción: El incremento del número de personas poseedoras de un estoma, trae consigo la necesidad de contar con personal capacitado para proporcionarle los elementos necesarios para su reintegración a la vida social, familiar y laboral. Objetivo: Analizar el efecto que tiene la intervención educativa de enfermería para la rehabilitación de personas con una ostomia. Metodología: Se trata de un estudio de tipo cuasi-experimental, la muestra se constituyó de 110 personas ostomizadas de cuatro hospitales a las que se les aplicó un instrumento que fue validado por expertos en el área. Para el análisis de datos se utilizó estadística descriptiva e inferencial por medio de la X2. Resultados: En los resultados se observa diferencia estadísticamente significativa entre la intervención educativa y la rehabilitación laboral (p=0.000), también se observo diferencia estadísticamente significativa entre la intervención educativa y la rehabilitación social y familiar (p=0.000). Discusión: Coincidiendo con Montovani en donde afirma que la falta de información, educación y comunicación son la causa para que el paciente no pueda participar activamente en su autocuidado. De acuerdo con Boccardo se establece que la mayoría de los pacientes ostomizados no retornan totalmente al trabajo pero si parcialmentea sus actividades siendo ésta la parte más difícil de superar. Conclusiones: Se sustenta que la intervención educativa en personas ostomizadas planificada,estandarizada y evaluada, es fundamental para lograr su rehabilitación educativa, laboral, social y familiar.