Association Between Health-Related Quality of Life, Obesity, Fitness, and Sleep Quality in Young Adults: The Cuenca Adult Study.

OBJECTIVE: The objectives of this study were to examine in university students: (a) the mean differences in the HRQoL among fat mass percentage, cardiorespiratory fitness (CRF) and sleep quality categories; and (b) the independent associations among fat mass percentage, CRF, and sleep quality with HRQoL. PARTICIPANTS: 376 students, 18-30 years old, from the University of Castilla-La Mancha in Cuenca, Spain (during 2009-2010). METHOD: Cross-sectional study measuring % fat mass (DXA), CRF (20-m shuttle run test), sleep quality (Pittsburgh Sleep Quality Index), and HRQoL (SF-12 questionnaire). RESULTS: The mean in Mental Component Summary (MCS) in men (p = .029) was lower in students in upper quartiles of % fat mass than in peers in other categories of % fat mass. Among men, MCS was significantly lower among those in the lowest quartile of CRF (p = .015), and among women, Physical Component Summary (PCS) was significantly lower among those in the lowest quartile of CRF (p = .047). MCS dimension of the HRQoL was lower in both men (p = .001) and women (p < .001) in upper quartiles of sleep quality. Multiple linear regression models showed that in men, CRF was associated with MCS (ß = 0.25, p = .031), and sleep quality was associated with PCS (ß = -0.24, p = .027) and MCS (ß = -0.38, p < .001). In women, CRF was associated with PCS (ß = 0.17, p = .018) and sleep quality with MCS (ß= -0.44, p < .001). CONCLUSIONS: Finally, our findings suggest that, regardless of adiposity and fitness, having good sleep habits may positively influence the quality of life in young adults.

Physical activity intervention (Movi-Kids) on improving academic achievement and adiposity in preschoolers with or without attention deficit hyperactivity disorder: study protocol for a randomized controlled trial.

BACKGROUND: The prevention of obesity and improvement of academic achievement in children are concerns of industrialized societies. Obesity has been associated with psychological disorders, including attention deficit hyperactivity disorder, whose prevalence has been estimated at 6.8 % in Spanish children and adolescents. It is known that physical activity is positively related to academic achievement and negatively related to the risk of obesity in children. However, studies to test the effectiveness of physical activity interventions in improving academic achievement in preschool children are scarce and have some weaknesses that threaten their validity. Moreover, very few studies have examined their effectiveness in improving symptoms of attention deficit hyperactivity disorder. This paper outlines a two-year multidimensional preschool intervention (Movi-Kids) aimed at preventing obesity and improving academic achievement in children with or without attention deficit hyperactivity disorder. METHODS/DESIGN: Twenty-one schools from Ciudad Real and Cuenca, Spain, were randomized to intervention and control groups. In the first academic year, children in the third grade of preschool and the first grade of primary school in the intervention group received the Movi-Kids intervention. In the second academic year, schools were crossed over to the other group. The intervention included children, parents and teachers, and the school environment, and consisted of: (i) three hour-long sessions of recreational non-competitive physical activity after school, weekly, (ii) educational materials for parents and teachers addressing sedentary lifestyle risks and (iii) playground modifications to promote physical activity during breaks. Primary outcome measures of this study were academic achievement (intelligence, cognition, memory, attention and perception), assessed by the Battery of General and Differential Aptitudes, and adiposity measures (body mass index, waist circumference, triceps skinfold thickness and body fat percentage). Secondary outcome measures were: attention deficit hyperactivity disorder risk, motor skills, health-related quality of life and sleep quality. These variables will all be measured in both groups at baseline and at the end of the first and second academic years. DISCUSSION: It seems reasonable that an intervention to promote physical activity based on playground games will be useful for simultaneously improving academic achievement and controlling obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT01971827 .

Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: a cluster randomized trial.

BACKGROUND: Studies that have examined the impact of a physical activity intervention on cardiometabolic risk factors have yielded conflicting results. The objective of this study was to assess the impact of a standardized physical activity program on adiposity and cardiometabolic risk factors in schoolchildren. METHODS: Cluster randomized trial study of 712 schoolchildren, 8-10 years, from 20 public schools in the Province of Cuenca, Spain. The intervention (MOVI-2) consisted of play-based and non-competitive activities. MOVI-2 was conducted during two 90-minute sessions on weekdays and one 150-minute session on Saturday mornings every week between September 2010 and May 2011. We measured changes in adiposity (overweight/obesity prevalence, body mass index [BMI], triceps skinfold thickness [TST], body fat %, fat-free mass, waist circumference) and other cardiometabolic risk factors (LDL-cholesterol, triglycerides/HDL-cholesterol ratio, insulin, C-reactive protein and blood pressure). The analyses used mixed regression models to adjust for baseline covariates under cluster randomization. RESULTS: Among girls, we found a reduction of adiposity in intervention versus control schools, with a decrease in TST (-1.1 mm; 95% confidence interval [CI] -2.3 to -0.7), body fat % (-0.9%; 95% CI -1.3 to -0.4), waist circumference (-2.7 cm; 95% CI -4.5 to -0.9), and an increase in fat-free mass (0.3 kg; 95% CI 0.01 to 0.6). The intervention also led to lower serum LDL-cholesterol and insulin levels. Among boys, a reduction in waist circumference (-1.4 cm; 95% CI -2.6 to -0.1; P = 0.03), and an increase in fat-free mass (0.5 kg; 95% CI 0.2 to 0.9; P = 0.003) was associated with the intervention versus control schools. The prevalence of overweight/obesity or underweight, BMI, and other cardiometabolic risk factors was not modified by the intervention. No important adverse events were registered. CONCLUSIONS: An extracurricular intervention of non-competitive physical activity during an academic year, targeting all schoolchildren regardless of body weight, is a safe and effective measure to reduce adiposity in both genders and to improve cardiometabolic risk profile in girls. TRIAL REGISTRATION: Clinical trials NCT01277224.

Protocolo de un ensayo aleatorizado de clusters para evaluar la efectividad del programa MOVI-2 en la prevención del sobrepeso en escolares / Protocol of a randomized cluster trial to assess the effectiveness of the MOVI-2 program on overweight prevention in schoolchildren

Introducción y objetivos. Se ha demostrado que el programa MOVI de actividad física recreativa durante los días lectivos reduce la adiposidad y mejora el perfil lipídico en escolares. Sin embargo, puede que la mayor actividad física durante la semana se compensara con mayor sedentarismo en el fin de semana, de forma que MOVI no alcanzara toda su efectividad potencial. Por ello diseñamos el programa MOVI-2, que también incluye actividad física durante el fin de semana. Se comunican la justificación y los métodos de un ensayo sobre la efectividad de MOVI-2 en la prevención del sobrepeso y la reducción del riesgo cardiovascular en 1.200 escolares de cuarto y quinto curso de primaria en Cuenca. Métodos. Se asigna aleatoriamente a 10 colegios al programa MOVI-2 y 10 colegios al grupo de control. MOVI-2 consiste en actividad física recreativa en horario extraescolar, con dos sesiones de 90 min en días lectivos y una sesión de 150 min los sábados, durante cada semana de un curso académico. Se espera que el grupo control mantenga la actividad física habitual. Las variables principales, que se miden en cada niño al inicio y final de MOVI-2, son: peso y talla, perímetro de cintura, pliegue cutáneo tricipital, porcentaje de grasa corporal, presión arterial, perfil lipídico y resistencia a la insulina. Las variables secundarias son: actividad física realizada, condición física, calidad de vida y del sueño, rendimiento académico, disfrute con la actividad física y autoconcepto físico. Conclusiones. Este estudio informará de si MOVI-2 supera algunas limitaciones potenciales de las intervenciones de actividad física en escolares (número Clinicaltrials.gov, NCT01277224) (AU)

Introduction and objectives. The MOVI physical activity program has been shown to reduce adiposity and to improve serum lipid profiles in schoolchildren. However, MOVI may have not achieved its maximum potential effectiveness, as increased physical activity on weekdays may have been offset by more sedentary behavior at weekends. We therefore developed the MOVI-2 program, which includes physical activity at weekends as well. This paper reports the rationale and methods of a trial to assess the effectiveness of MOVI-2 in preventing overweight and reducing cardiovascular risk in 1200 4th- and 5th-grade primary schoolchildren in Cuenca, Spain. Methods. Ten schools were randomly assigned to MOVI-2 and 10 schools to the control group. MOVI-2 consisted of recreational physical activity in after-school time, including two 90-min sessions on weekdays and one 150-min session on Saturdays, during each week of one academic year. The control group was expected to follow their usual patterns of physical activity. The primary end points, which were assessed at the start and the end of the MOVI-2 program, were weight and height, waist circumference, skinfold thickness, percentage of body fat, blood pressure, lipid profile, and insulin resistance. Secondary end points were physical activity, fitness, health-related quality of life, sleep quality, academic performance, enjoyment with physical activity, and physical self-concept. Conclusions. This study will assess whether MOVI-2 overcomes some potential limitations of physical activity interventions in children (Clinicaltrials.gov number NCT01277224) (AU)

Protocol of a randomized cluster trial to assess the effectiveness of the MOVI-2 program on overweight prevention in schoolchildren.

INTRODUCTION AND OBJECTIVES: The MOVI physical activity program has been shown to reduce adiposity and to improve serum lipid profiles in schoolchildren. However, MOVI may have not achieved its maximum potential effectiveness, as increased physical activity on weekdays may have been offset by more sedentary behavior at weekends. We therefore developed the MOVI-2 program, which includes physical activity at weekends as well. This paper reports the rationale and methods of a trial to assess the effectiveness of MOVI-2 in preventing overweight and reducing cardiovascular risk in 1200 4th- and 5th-grade primary schoolchildren in Cuenca, Spain. METHODS: Ten schools were randomly assigned to MOVI-2 and 10 schools to the control group. MOVI-2 consisted of recreational physical activity in after-school time, including two 90-min sessions on weekdays and one 150-min session on Saturdays, during each week of one academic year. The control group was expected to follow their usual patterns of physical activity. The primary end points, which were assessed at the start and the end of the MOVI-2 program, were weight and height, waist circumference, skinfold thickness, body fat percentage, blood pressure, lipid profile, and insulin resistance. Secondary end points were physical activity, fitness, health-related quality of life, sleep quality, academic performance, enjoyment with physical activity, and physical self-concept. CONCLUSIONS: This study will assess whether MOVI-2 overcomes some potential limitations of physical activity interventions in children (Clinicaltrials.gov number NCT01277224).

Flúter IC / Class IC atrial flutter

La presencia de fármacos antiarrítmicos en los tratamientos habituales de los pacientes es un hecho frecuente en las consultas de Atención Primaria, fundamentalmente en aquellos con diagnósticos de fibrilación auricular y flúter, que generalmente precisan medicación de forma indefinida. Los efectos secundarios derivados de su utilización son múltiples y variados y, aunque se encuentran ampliamente descritos en la literatura, conviene conocerlos por su uso habitual y su potencial peligro. La flecainida es un antiarrítmico de clase IC, de uso común en pacientes con fibrilación auricular, que puede presentar un efecto proarrítmico como complicación. Presentamos el caso de un paciente con diagnóstico de fibrilación auricular en tratamiento con flecainida que derivó en una taquicardia regular con QRS ancho por conducción aurículo-ventricular 1:1, conocido como flúter IC, provocando inicialmente confusión en el diagnóstico (AU)

Antiarrythmic drugs commonly form part of the treatment regimens of primary care patients, especially in those with diagnosis of atrial fibrillation and flutter, conditions which usually require medication indefinitely. The side effects from their use are multiple and varied, and although these are widely described in the literature, it is advisable to be familiar with adverse effects, due to the frequent use of antiarrythmics and their potential danger. For example, flecainide, a class IC antiarrhythmic agent commonly used in patients with atrial fibrillation, can have proarrhythmic effects. We report the case of a patient previously diagnosed with atrial fibrillation and treated with flecainide, who developed regular wide QRS tachycardia with 1:1 atrioventricular conduction, known as class IC atrial flutter, causing initial confusion in diagnosis (AU)

Cistitis y pielitis enfisematosas: otra complicación en el paciente diabético / Emphysematous cystitis and pyelitis: another complication in diabetic patients

La cistitis enfisematosa es una complicación poco frecuente que suele estar asociada a diferentes factores de riesgo, fundamentalmente a la Diabetes Mellitus. Presenta clínica inespecífica de irritación vesical y dolor abdominal revelándose habitualmente como un hallazgo radiológico. La tomografía computarizada abdominal es la prueba diagnóstica de elección. El tratamiento requiere estricto control glucémico, antibioterapia intensiva y drenaje urinario de forma precoz con lo que se resuelven la mayoría de los casos. Puede complicarse afectando a cualquier parte del sistema urinario lo que empeora el pronóstico(AU)

Emphysematous cystitis is a rare complication that is often associated with different risk factors mainly diabetes mellitus. Presents nonspecific clinical bladder irritation and abdominal pain usually revealed as a radiological finding. Abdominal computed tomography is the method of choice for diagnosis. Treatment requires strict glycemic control, early and intensive antibiotic therapy and urinary drainage that solve most cases. It can be complicated to affect any part of the urinary system which worsens the prognosis(AU)

Validez de un modelo con un único factor en el síndrome metabólico en adultos jóvenes: análisis factorial confirmatorio / Validity of a Single-Factor Model Underlying the Metabolic Syndrome in Young Adults: Confirmatory Factor Analysis

Introducción y objetivos Comparar mediante análisis factorial confirmatorio si un modelo de síndrome metabólico que como medida de adiposidad incluye la razón perímetro de cintura/estatura tiene mejor bondad de ajuste que el que incluye el perímetro de cintura y, a partir de los datos del modelo de mejor ajuste, desarrollar un índice de riesgo cardiometabólico global en adultos jóvenes.MétodosEstudio observacional transversal en el que participaron 683 estudiantes universitarios de 18 a 30 años de primer curso de la Universidad de Castilla-La Mancha durante el curso 2009/2010. Se comparó el mejor ajuste de dos modelos de síndrome metabólico; ambos incluían la razón triglicéridos/colesterol unido a lipoproteínas de alta densidad, índice HOMA-IR, presión arterial media y uno de ellos incluía el perímetro de cintura y otro, la razón perímetro cintura/estatura. Se construyó un índice de síndrome metabólico (ISM) y se estimó su asociación con la capacidad aeróbica, con la actividad física diaria y con la fuerza muscular.ResultadosEl modelo unifactorial que incluía el perímetro de cintura mostró mejores indicadores de bondad de ajuste. El ISM se asoció inversamente con la capacidad aeróbica y la fuerza muscular.ConclusionesNuestro estudio corrobora que un solo factor subyace al concepto síndrome metabólico; la razón perímetro de cintura/estatura no aporta mejoras sobre considerar el perímetro de cintura solamente, y el desarrollo de un ISM cuantitativo puede ser útil para la cuantificación del riesgo cardiometabólico en la práctica clínica (AU)

Introduction and objectives To determine by confirmatory factor analysis whether a model of the metabolic syndrome including waist circumference-to-height ratio, as a measure of adiposity, has better goodness of fit than that based on waist circumference alone and, on the basis of the data of the best-fit model, to develop an index of global cardiometabolic risk in young adults.MethodsCross-sectional observational study involving 683 university students aged 18 to 30years, in their first year at the University of Castilla-La Mancha in Spain, during the 2009-10 academic year. We compared the best fit of 2 models of the metabolic syndrome, both of which included the triglyceride-to-high-density lipoprotein cholesterol ratio, HOMA-IR index, and mean arterial blood pressure, but differed in that one of them used waist circumference, whereas the other used the waist circumference-to-height ratio. A metabolic syndrome index (MSI) was constructed and its association with aerobic capacity, daily physical activity and muscle strength was estimated.ResultsThe single-factor model that included waist circumference was a better indicator of goodness of fit. The MSI was inversely associated with aerobic capacity and muscle strength.ConclusionsThis study confirms that a single factor underlies the concept of metabolic syndrome; including the waist circumference-to-height ratio does not result in improvements over the model in which waist circumference alone is considered, and the development of a quantitative MSI may be useful for the quantification of cardiometabolic risk in clinical practice (AU)

[Validity of a single-factor model underlying the metabolic syndrome in young adults: confirmatory factor analysis]. / Validez de un modelo con un único factor en el síndrome metabólico en adultos jóvenes: análisis factorial confirmatorio.

INTRODUCTION AND OBJECTIVES: To determine by confirmatory factor analysis whether a model of the metabolic syndrome including waist circumference-to-height ratio, as a measure of adiposity, has better goodness of fit than that based on waist circumference alone and, on the basis of the data of the best-fit model, to develop an index of global cardiometabolic risk in young adults. METHODS: Cross-sectional observational study involving 683 university students aged 18 to 30 years, in their first year at the University of Castilla-La Mancha in Spain, during the 2009-10 academic year. We compared the best fit of 2 models of the metabolic syndrome, both of which included the triglyceride-to-high-density lipoprotein cholesterol ratio, HOMA-IR index, and mean arterial blood pressure, but differed in that one of them used waist circumference, whereas the other used the waist circumference-to-height ratio. A metabolic syndrome index (MSI) was constructed and its association with aerobic capacity, daily physical activity and muscle strength was estimated. RESULTS: The single-factor model that included waist circumference was a better indicator of goodness of fit. The MSI was inversely associated with aerobic capacity and muscle strength. CONCLUSIONS: This study confirms that a single factor underlies the concept of metabolic syndrome; including the waist circumference-to-height ratio does not result in improvements over the model in which waist circumference alone is considered, and the development of a quantitative MSI may be useful for the quantification of cardiometabolic risk in clinical practice.

Síndrome de intestino corto / Short bowel syndrome

El síndrome de intestino corto es un cuadro clínico caracterizado por una importante disminución de la superficie intestinal efectiva por una pérdida anatómica o funcional del intestino delgado. Aparece sobre todo tras resecciones intestinales extensas por isquemia mesentérica. Sus principales complicaciones son diarrea, deshidratación, pérdida de peso, desnutrición, déficit de electrolitos, vitaminas y oligoelementos. Un soporte nutricional adecuado e individualizado constituye la base del tratamiento. Presentamos el caso de un varón joven con estado de hipercoagulabilidad y síndrome de intestino corto que presentó un síndrome confusional por abandono en la dieta y tratamiento, expresándose como una encefalopatía de Wernicke(AU)

Short bowel syndrome is characterized by a significant reduction in the effective intestinal surface by an anatomical or functional loss of the small intestine. It mainly occurs after extensive bowel resection due to mesenteric ischemia. The main complications are diarrhoea, dehydration, weight loss, malnutrition, and electrolyte, vitamin and trace element deficiency. Treatment is based on appropriate, individualized nutritional support. We report the case of a young man with a hypercoagulable state and short bowel syndrome who presented with a confusional state due to non-compliance to diet and treatment, expressed as a Wernicke encephalopathy(AU)

Dolor abdominal persistente / Persistent abdominal pain

El dolor abdominal es un motivo frecuente de consulta en atención primaria y urgencias, y constituye el síntoma más común en patología digestiva. La invaginación intestinal consiste en la introducción de una porción de intestino en otro distal y constituye una causa poco habitual de dolor abdominal en adultos, no obstante supone la causa mas frecuente de obstrucción intestinal en lactantes y niños menores de 5 años. Se presenta el caso de una mujer de 14 años con dolor abdominal persistente por invaginación intestinal(AU)

Abdominal pain is a frequent complain in primary care and emergency departments, and is the most common symptom in gastrointestinal disorders. Intussusception occurs when a segment of bowel invaginates into the distal bowel and it is not a common cause of abdominal pain in adults, however, it is the most common cause of intestinal obstruction in infants and children under 5 years. We report a case of a fourteen year old girl with persistent abdominal pain due to intussusception(AU)

Plasmocitoma óseo solitario / Solitary bone plasmocytoma

El dolor lumbar crónico constituye un motivo frecuente de consulta y, aunque en la mayoría de las ocasiones presenta un carácter mecánico, en un 1-5 % demuestra un origen neoplásico .El plasmocitoma óseo solitario es un tumor de células plasmáticas poco habitual que asienta principalmente en la columna vertebral, provocando dolor sobre todo a nivel torácico y/o lumbar. Se presenta el caso de una mujer de 78 años con dolor lumbar crónico y síndrome de POEMS, en la que se halló una imagen ósea lítica en una radiografía lumbar, correspondiente a un plasmocitoma óseo solitario que se confirmó mediante biopsia (AU)

Chronic low back pain is a common reason for visiting the doctor and although in most cases it has a mechanical character, 1-5% are of neoplasic origin. Solitary bone plasmacytoma is a rare plasma cell tumor located mainly in the spine, causing pain especially in the thoracic and lumbar region. We report the case of a 78 year old woman with chronic back pain and POEMS syndrome, in which a lytic bone image was found in a lumbar radiography corresponding to a solitary bone plasmacytoma confirmed by biopsy (AU)

Corea inducida por Antiparkinsonianos / Chorea induced by Parkinson’s disease treatment

La corea constituye un trastorno del movimiento hipercinético caracterizado por movimientos breves, irregulares, rápidos e impredecibles, que cambian de una parte corporal a otra. Puede ser hereditaria, siendo la Enfermedad de Huntington su principal causa, o adquirida, donde los fármacos representan su origen más común en la práctica clínica. La levodopa puede originar corea como una complicación del tratamiento prolongado en pacientes con Enfermedad de Parkinson. Su tratamiento precisa disminución de dosis y control sintomático en función de la intensidad y repercusión funcional de la corea (AU)

Chorea is a hyperkinetic movement disorder characterized by brief movements, irregular, rapid and unpredictable changing of a body part to another. It may be hereditary, being Huntington’s disease the main cause, or acquired, where drugs represent the most common cause in clinical practice. Levodopa may cause chorea as a complication of prolonged treatment in patients with Parkinson’s disease. Its treatment required dose reduction and symptom control in function of the intensity and functional impact of chorea (AU)

La práctica del Tai Chi previene las caídas en el anciano institucionalizado: un ensayo clínico / The practice of Thai-Chi prevents falls in the institutionalized elderly: a clinical trial

Objetivo. Determinar si la práctica de dos horas de Tai Chi semanal durante 9 meses disminuye el riesgo de caídas en ancianos de edad igual o superior a 65 años. Diseño. Ensayo clínico con aleatorización por grupos sin cegamiento. Emplazamiento. Dos residencias de ancianos de la ciudad de Cuenca. Participantes. Un total de 94 ancianos institucionalizados, de entre 65 y 90 años. Grupo control de 43 y grupo de intervención de 51 practicantes de Tai Chi. Mediciones principales. Mediante entrevista semanal, realizada por uno de los investigadores, se recogieron como eventos principales el número de caídas, número de fracturas, número de tropiezos y pérdidas de equilibrio. Resultados. La incidencia de caídas en el grupo de Tai Chi fue del 13,7% y en el grupo control del 32,5% (p < 0,03); Razón de Riesgo [RR] = 0,42, lo que supone una Reducción de Riesgo (RAR) del 18,8%. Como resultado de estas caídas, 5 ancianos de los controles(11,6%) sufrieron fracturas óseas y ninguna en el grupo de Tai Chi (p < 0,02). Encontramos diferencias estadísticamente significativas en cuanto al número de tropiezos, 16 en el grupo de Tai Chi (31,3%) y 49 en los controles (113,9%) (p<0,04; RR = 0,28; RAR = 0,826).Igualmente las diferencias en el número de pérdidas de equilibrio fue significativa, 12 en el grupo de Tai Chi (23,5%) y 37 en el grupo control (86%) (p < 0,02; RR = 0,27; RAR =0,625).Conclusiones. La práctica regular de Tai Chi probablemente disminuye el número de caídas, la incidencia de fracturas, el número de tropiezos y las pérdidas de equilibrio en pacientes ancianos institucionalizados (AU)

Objective. To determine whether practicing Thai Chi for 2 hours a week for 9 months decreases the risk of falls in elderly people aged 65 years or over living in residential care homes. Design. Randomised, non-blind clinical trial with two groups. Setting. Two residential care homes in the city of Cuenca. Participants. A total of 94 institutionalized elderly persons between 65 and 90 years. The control group comprised 43 persons and the Thai Chi group 51 persons. Main measurements. The main measurements were number of falls and their severity, the number of stumbles and losses of balance determined by a weekly interview with one of the investigators. Results. The incidence of falls was 13.7% in the Tai Chi group and 32.5% in the control group. (p <0.03); Relative Risk, (RR) = 0.42, representing a risk reduction of 18.8%. Five elderly persons in the control group (11.6%) and none in the Thai Chi Group (p< 0.02) suffered bone fractures as result of the falls. We found significant differences in the number of stumbles, 16 in the Thai Chi group (31.3%) and 49 in control group (113.9%) (p<0.04;RR = 0.28; RAR = 0.826). Likewise, the differences in the number of losses of balance was significant, 12 in the Thai Chi group (23.5%) and 37 in the control group (86%) (p < 0.02;RR = 0.27; RAR = 0.625).Conclusions. Regular Thai Chi practice may reduce the number of falls, the incidence of bone fractures, the number of stumbles and losses of balance in elderly people living in residential care homes (AU)

Ambliopía tabaco alcohol / Tobacco-alcohol amblyopia

Las neuropatías ópticas nutricionales (NON) suelen ser de evolución crónica, lentamente progresivas, indoloras y de afectación bilateral. El alcoholismo y el tabaco son las causas más comunes de neuropatía óptica tóxica (NOT) a las que se suele asociar un déficit vitamínico, constituyendo la llamada ambliopía tabaco-alcohol. Deben sospecharse en pacientes desnutridos y con hábitos tóxicos, que presentan disminución de la agudeza visual. La funduscopia puede revelar edema o palidez del nervio óptico con evolución hacia la atrofia óptica, aunque habitualmente se encuentra preservado. El tratamiento se basa en la reposición de vitaminas y nutrientes deficitarios, y en la suspensión inmediata del tóxico (AU)

Nutritional optic neuropathies (NON) are usually chronic, progressive, painless and with bilateral involvement. Alcoholism and tobacco are the most common causes of toxic optic neuropathy (TON) which is often associated with a vitamin deficiency, constituting tobacco alcohol amblyopia. This should be suspected in patients with malnutrition with heavy use of either or both of these substances and who have decreased visual acuity. Fundoscopy may reveal o edema or pallor of the optic nerve progressing to optic atrophy, although it is usually preserved. Treatment is based on vitamin and nutrient supplementation, and the immediate cessation of smoking or alcohol consumption (AU)

Elevación crónica de creatincinasa / Chronic creatinine elevation

Las miopatías son entidades en las que se produce afectación musculo esquelética con elevación de creatincinasa en suero. La Enfermedad de Addison y la Hipertermia Maligna constituyen causas poco comunes de miopatía. La Enfermedad de Addison corresponde a una insuficiencia suprarrenal primaria producida por un déficit de glucocorticoides, mineral corticoides y andrógenos por destrucción de la corteza suprarrenal, cuyos síntomas son inespecíficos y el tratamiento es con hidrocortisona. La Hipertermia Maligna se produce por una alteración genética en la que los anestésicos inhalados y los relajantes musculares desencadenan una hipertermia progresiva, con rigidez muscular, taquicardia, hipotensión, rabdomiolisis, y coagulación intravascular diseminada (AU)

Myopathy is a disease that affects the musculoskeletal system with elevated serum creatinine. Addison’s Disease and Malignant Hyperthermia, are rare causes of myopathy. Addison’s disease, also known as primary adrenal insufficiency, occurs when the adrenal gland does not produce enough glucocorticoids, mineralocorticoids and androgens because of the destruction of the adrenal cortex. Symptoms are non-specific and it is treated with hydrocortisone. Malignant Hyperthermia is a genetic disorder, in which inhaled anaesthetics and muscle relaxants, trigger progressive hyperthermia with muscle rigidity, tachycardia, hypotension, rhabdomyolysis, and disseminated intravascular coagulation (AU)

“El corazón más grande que la caja”: un caso de Cor Pulmonale / “The heart bigger than the box”: a case of Cor Pulmonale

El Cor Pulmonale (CP) se produce como resultado de un aumento de la presión en los pulmones, lo que origina un incremento en el tamaño del ventrículo derecho (VD) por sobrecarga. Aproximadamente un 20-30% de los ingresos hospitalarios por insuficiencia cardiaca congestiva se debe a insuficiencia ventricular derecha asociada a CP. La causa más común es la EPOC (enfermedad pulmonar obstructiva crónica). La clínica, el electrocardiograma y la radiografía de tórax son inespecíficos. El método diagnóstico no invasivo de elección es el ecocardiograma-doppler, pero el cateterismo cardiaco es la prueba gold estándar. El tratamiento se basa en diuréticos, vasodilatadores y oxígeno a largo plazo (AU)

Cor pulmonale (CP) occurs when there is increased pressure in the lungs, causing enlargement of the right ventricle (VD) due to pressure overload. Approximately 20-30% of hospital admissions for congestive heart failure are due to right ventricular failure associated with CP. The most common cause is COPD (chronic obstructive pulmonary disease). The clinical, electrocardiogram, and chest X-ray examinations are non-specific. Doppler echocardiogram is the non-invasive diagnostic method of choice is, however cardiac catheterization is the gold standard. Treatment is based on diuretics, vasodilators and long-term oxygen (AU)

Fenómeno de Raynaud / Raynaud’s Phenomenon

El fenómeno de Raynaud se caracteriza por una disminución de la circulación sanguínea, fundamentalmenteen los dedos de las manos y de los pies, con dolor y cambios de coloración en la piel deuna forma secuencial: blanco, azul y rojo. Es más frecuente en las mujeres, en la 2ª y 3ª décadasde la vida. Se desconoce cuál es su causa, pero guarda relación con el consumo de tabaco, alcohol,y fundamentalmente con los cambios de temperatura y alteraciones emocionales. Se asocia aenfermedades del tejido conectivo, entre las que Esclerodermia y Lupus son las más frecuentes. ElNifedipino es el fármaco de primera elección(AU)

Raynaud’s phenomenon is characterized by a decrease in blood circulation mainly in the fi ngers andtoes, with pain and changes in skin colour which follow a characteristic pattern white, blue and red. Itis more common in women, in the 2nd and 3rd decade of life. The cause is unknown, but is related tosmoking and alcohol consumption, and particularly body temperature changes and emotional stress.It is associated with connective tissue diseases amongst which scleroderma and lupus are the mostfrequent. Nifedipine is the treatment of choice(AU)

Tasa de derivación y factores asociados a la calidad de la hoja de derivación en Atención Primaria / Influence of the primary care physician in the quantity and quality of referrals to Specialist Services

Objetivo. 1) Analizar la relación entre la cantidad y calidad de las hojas de interconsulta (IC) y los factores relacionados con el médico de familia (MF). 2) Conocer su distribución por especialidades.Diseño. Estudio descriptivo, transversal.Emplazamiento. Centro de salud urbano de la ciudad de Cuenca.Sujetos. Analizamos un total de 1.214 derivaciones realizadas a través del programa informático de explotación de datos (TURRIANO) por 7 MF, durante el último trimestre del año 2005.Mediciones principales. Se han analizado retrospectivamente las hojas de IC. Recogimos variables asociadas al MF y asociadas a la propia IC (especialidad a la que va dirigida, fecha y calidad). Se establecieron 3 categorías para valorar la calidad de las IC: “mala” (cumplía al menos uno de los criterios “ausencia de motivo de consulta y/o anamnesis de la enfermedad actual” y “ausencia de exploración física y/o exploraciones complementarias”), “aceptable” (presencia simultánea de los dos criterios anteriores) y “buena” (cumplía criterios de “aceptable” más la presencia de al menos uno de los siguientes: antecedentes familiares, antecedentes personales, tratamiento habitual, diagnóstico de sospecha).Resultados. La calidad de las derivaciones fue defi ciente en un 68,2%, aceptable en un 11,4%, y buena en un20,3%. Los servicios a los que más se derivó fueron Traumatología 14,7%, Oftalmología 11,8%, Ginecología11% y Dermatología 10,1%.La proporción de derivaciones buena/aceptable en las especialidades más demandadas fue: Dermatología66,7%, Traumatología 29,1%, Otorrinolaringología 23,3%, Ginecología 19,5% y Oftalmología 16,8%. En cuantoa la calidad aceptable/buena de la interconsulta, la variable formación MIR presentó una diferencia estadísticamente significativa (p = 0,03). El 28,6% tenía formación MIR, el 57,1% eran tutores y el 57,1% hombres.Conclusiones. El número de IC realizadas por un equipo de Atención Primaria (EAP) a Atención Especializada(AE) es una referencia de su correcto funcionamiento y de su capacidad de resolución. Encontramos una granvariabilidad en el número de las IC entre los distintos médicos, que no parece justifi carse por el número detarjetas y el volumen de trabajo. Disponer de formación especializada y tutorizar residentes parece relacionarsecon mayor capacidad de cumplimentación y calidad de las interconsultas

Objective. To analyze the relationship between the quantity and quality of referrals and factors related to the family physician (FP). To determine their distribution by specialities.Design. Descriptive, cross study.Setting. Primary care centre in Cuenca city.Subjects. We analyzed a total of 1,214 referrals, using the software package (TURRIANO), made by 7 familyphysicians during the last quarter of 2005.Main measurements. Referral forms were analysed retrospectively. We compiled variables associated with the family physician (fi gure 1) and with the referral itself (speciality to which it is addressed, date and quality).Three categories were established to assess the quality of referrals. Poor quality referrals met at least one ofthe 2 following criteria “lack of consultation reason (MC) and/or current history of the disease (AD)” and “lack of physical (PE) and/or complementary tests (CT)”. In acceptable referrals, the two previous criteria were present simultaneously. Finally, a referral was evaluated as good if it fulfi lled all the criteria for being acceptable plus thepresence of at least one of the following: Family history, personal history, routine treatment, diagnosis.Results. We analyzed 1,214 referrals. The quality of the referrals was poor in 68.2%, acceptable in 11.4% andgood in 20.3%. The services that most referrals were made to were Traumatology 14.7%, Ophthalmology 11.8%,Gyneacology 11%, and Dermatology 10.1%. The proportion of good/acceptable referrals in the most popularspecialities were: Dermatology 66.7%, Traumatology 29.1%, Otolaryngology 23.3%, Gyneacology 19.5% andOphthalmology 16, 8%.With regard to the acceptable /good quality of the referral only the variable training (MIR) presented a statisticallysignifi cant difference (p = 0, 03). Of the doctors considered, 28. 6% had MIR training, 57.1% were tutors and 57.1% were male.Conclusions. The number of referrals made by a Primary Health Care team (PC) to Specialist care (SC) is relatedto correct performance of this team and their ability to solve problems in their daily work.In our study there was a great variability in the number of referrals made by different doctors, which does notappear to be justifi ed by the number of cards and workload. Having specialist training and tutoring residents appears to be associated with a greater capacity and quality completion of referrals