Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study. / Características clínicas y epidemiológicas de pacientes diagnosticados de escabiosis en España: oportunidades de mejora. Estudio transversal multicéntrico CLINI-AEDV.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

[Translated article] Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

Peer-based intervention for acute stress reaction: adaptations by five militaries.

Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.

Desarrollo genital prenatal. Clasificación, diagnóstico y manejo de las anomalías de la diferenciación sexual / Prenatal genital development. Classification, diagnosis, and management of abnormalities of sexual differentiation

Revisión de la etiopatogenia y clasificación de las anomalías de la diferenciación sexual, así como del desarrollo genital prenatal, para que resulte de utilidad en la evaluación y manejo diagnóstico, mediante una búsqueda bibliográfica de la literatura más actual publicada a través de las bases de datos PubMed, MedLine, Embase, BioMed Central y SciELO. Las anomalías de la diferenciación sexual comprenden un amplio espectro de enfermedades que pueden desarrollarse en diferentes etapas de la vida. Estas anomalías requieren un manejo y evaluación compleja multidisciplinar en la que el obstetra desarrolla un papel fundamental, siendo referente en el diagnóstico prenatal de estas. La discordancia entre el sexo genético determinado por el test prenatal no invasivo y el fenotípico observado por medio de la ecografía es un hallazgo cada vez más frecuente, con una incidencia de 1 por cada 1.500-2.000 embarazos. La detección temprana de esta discordancia puede orientar la sospecha clínica y mejorar el manejo de las anomalías del desarrollo sexual desde la etapa prenatal.(AU)

To review the most current literature on the aetiopathogenesis and classification of abnormalities of sexual differentiation, as well as prenatal genital development. A literature search through PubMed, MedLine, Embase, BioMed Central, and SciELO databases was conducted. Abnormalities of sexual differentiation comprise a wide spectrum of diseases that can develop at different stages of life. These anomalies require complex evaluation by a multidisciplinary team in which the obstetrician plays a fundamental role in prenatal diagnosis. Discrepancy between the genetic sex determined by non-invasive prenatal testing and the phenotypic sex observed by ultrasound is an increasingly frequent finding, with an incidence of 1 in 1,500-2,000 pregnancies. Early detection of this discrepancy can guide clinical suspicion and improve the management of different sexual developmental anomalies from the prenatal period.(AU)

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team.

OBJECTIVE: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS: Four significant themes emerged from the analysis: (1) delirium prevention, (2) pharmacological treatment, (3) non-pharmacological treatment, and (4) barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

Prevenir y tratar delirium en cuidados intensivos: hermenéutica de las vivencias del equipo de enfermería / Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team

Objetivo:Comprender las vivencias del cuidado de enfermería frente a la prevención y el tratamiento del delirium en personas hospitalizadas en unidades de cuidados intensivos. Metodología:Estudio cualitativo fenomenológico hermenéutico. La selección de participantes fue por muestreo intencionado: 7 auxiliares de enfermería y 8 enfermeras. Se logró la saturación teórica. Se aplicó la entrevista fenomenológica para la recolección de datos a partir de una pregunta central, y el análisis se realizó siguiendo los planteamientos del círculo hermenéutico de Heidegger. Resultados: Del análisis, emergieron 4 temas significativos: 1) Prevención del delirium, 2) Tratamiento farmacológico, 3) Tratamiento no farmacológico y 4) Barreras para el tratamiento no farmacológico. Estos temas estuvieron acompañados de 35 unidades de significado vinculadas entre sí: en el primer tema, las unidades más reiterativas fueron comunicación, orientación y vinculación de la familia; en el segundo tema fue el uso de tratamiento farmacológico solo en fase aguda; en el tercer tema fue la modificación del ambiente según preferencia del paciente (donde la familia es prioritaria y permite reforzar estrategias que brinden una estimulación cognitiva y social), y en el cuarto tema fue la sobrecarga laboral para el equipo de enfermería. Conclusiones: Las experiencias del equipo de enfermería en la prevención y el tratamiento del delirium en pacientes críticos destacan que la comunicación permite un acercamiento al paciente como ser humano inmerso en una realidad, con una historia personal, con necesidades y preferencias. Por lo tanto, en estos escenarios debe vincularse su familia, ya que puede complementar y apoyar del cuidado de enfermería.(AU)

Objective: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. Methodology: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview wasapplied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. Results: Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. Conclusions: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.(AU)

Enfermedad hemolítica perinatal en recién nacido por aloinmunización anti-E / Foetal Haemolytic Disease in a new-born with Anti-E alloimmunization

AntecedentesLa aloinmunización anti-E es una etiología rara de enfermedad hemolítica perinatal (EHP). Su incidencia es muy baja, y menos del 3% es grave. Dado que la titulación de anticuerpos no se correlaciona con la gravedad, resulta interesante notificar casos que requieren tratamiento en el periodo postnatal.ObjetivoReportar el caso de un recién nacido tratado con fototerapia y exanguinotransfusión por EHP por aloinmunizacion anti-E.CasoMujer 42 años, escrutinio de anticuerpos irregulares positivo con aloanticuerpos anti-E.ConclusionesSe requiere un manejo activo tanto en el periodo prenatal como neonatal de la aloinmunización anti-E. Aunque no se haya documentado anemia en el periodo fetal, el recién nacido sigue siendo de alto riesgo para la presentación de clínica compatible con enfermedad hemolítica en el periodo postnatal.

BackgroundAnti-E alloimmunization is a rare aetiology of haemolytic disease of the foetus and new-born (HDFN). The incidence is low, with less than 3% with severity criteria. Antibody titre does not correlate with severity, so cases that require treatment should be notified.ObjectiveTo report the case of a new-born who required phototherapy as treatment of HDFN secondary to anti-E alloimmunization.Case42-year-old woman, positive irregular antibody screening, with anti-E alloantibodies.ConclusionsActive management is required in both the prenatal and the neonatal period. Although anaemia has not been documented in the foetal period, the new-born is still at high risk for the presentation of symptoms compatible with haemolytic disease in the postnatal period.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team. / Prevenir y tratar delirium en cuidados intensivos: hermenéutica de las vivencias del equipo de enfermería.

OBJECTIVE: To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units. METHODOLOGY: Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle. RESULTS: Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team. CONCLUSIONS: The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

Caracterización de la gingivitis crónica en la población adolescente

Introducción: la gingivitis crónica es el proceso inflamatorio que afecta el periodonto de protección yaltera las características normales de la encía, con elevada prevalencia en los adolescentes.Objetivo: caracterizar la gingivitis crónica en los adolescentes de 11 a 19 años del Área Norte de Sancti Spíritus.Métodos: se realizó un estudio observacional, descriptivo y transversal cuyo universo quedó constituido por 61 adolescentes, que acudieron a la Clínica Estomatológica Docente Provincial durante el período de septiembre de 2019 a enero de 2020. Las variables estudiadas fueron: edad, sexo, factores de riesgo,aspecto anatomo clínico, gravedad de la enfermedad y conocimientos sobre gingivitis crónica. Se emplearon métodos del nivel teórico, empírico y de la estadística descriptiva.Resultados: predominó el grupo de edades de 17 a 19 años (45,9 Porciento), la higiene bucal deficiente (78,7Porciento) seguida de la caries dental (47,5Porciento) y el tabaquismo (40,9 Porciento). El nivel de conocimientos fue malo enel 72,1 Porciento y la gingivitis edematosa fue la que más afectó a los adolescentes, con mayor incidencia en elgrupo de 14 a 16 años (36,1 Porciento).Conclusiones: la gingivitis crónica, principalmente de tipo edematosa fue común en adolescentes masculinos y de edades entre 17 y 19 años. Factores de riesgo como una higiene bucal deficiente condicionan la aparición de la enfermedad. Es necesario incidir en el nivel de conocimientos de los adolescentes para prevenir la aparición de la enfermedad.[AU]

Extenso carcinoma del cuero cabelludo con invasión meníngea / Large Carcinoma of the Scalp Invading the Meninges

No disponible

[Influence of the covid-19 pandemic period of alert on perceived quality of hospital emergencies]. / Influencia del periodo de alarma por la pandemia covid-19 en la calidad percibida de la atención en urgencias hospitalarias.

OBJECTIVE: To assess changes in perceived quality in patients who required A&E hospital care before and during the COVID-19 period of alert. METHODS: Retrospective descriptive observational study using the «Net Promoter Score¼ (NPS), which classifies patients as promoters or detractors. Three perceived quality dimensions (accessibility, professionals, and information) were measured in 160 patients discharged home before alert, and in a further 160 in the first 2 months during alert. A standard of ≥90% promoters and ≤10% detractors was verified by lot acceptance (LQAS) in different access routes and times. Factors related to the probability that a patient was a promoter, or a detractor were analysed using logistic regression. RESULTS: The mean score was lower in accessibility than in the other dimensions (8.6 vs. 9.1 and 9.0, P<.0001). During alert, accessibility obtained better results (NPS 70 vs. 32, P<.001). Per access route, Paediatrics and Ophthalmology improved and Maternity did not experience changes. LQAS showed more lots accepted during alert (85 vs. 72%). The likelihood for a patient to be a promoter was higher during alert (OR 1.85, P<.0001), especially in accessibility (OR 3.08, P<0.0001). The likelihood to be a detractor was reduced (OR .54, P<.05), and also greater in accessibility (OR .39, P<.05). CONCLUSIONS: Perceived quality improved during the period of alert, its declaration being the most influential factor. This improvement is evident in paediatric and ophthalmological patients, but imperceptible in Maternity or Traumatology, perhaps because the pandemic acted as an adequacy corrector.

Efectos del envejecimiento en la cavidad bucal

Introducción: el proceso de envejecimiento es considerado un fenómeno universal, dinámico, irreversible, inevitable y progresivo, que involucra un cierto número de cambios fisiológicos, en su mayoría simplemente una declinación en la función del organismo como un todo. Objetivo: describir los efectos del envejecimiento en la cavidad bucal durante la tercera edad. Material y Métodos: se realizó una revisión bibliográfica en el período de abril a junio del 2018. La evaluación incluyó artículos de 21revistas, cubanas e internacionales. Las bases de datos MEDLINE, Pubmed y Scielo fueron consultadas usando los términos“envejecimiento”, “adulto mayor”, “enfermedades bucales”; para español e inglés, consultándose un total de 31 referencias.Desarrollo: el envejecimiento produce en la cavidad oral una serie de cambios graduales, irreversibles y acumulativos, a nivel de mucosa bucal, lengua, saliva, periodonto y tejidos dentales, lo que la vuelve más vulnerable a los agentes traumáticos e infecciosos, presentando una gran variedad de problemas bucales tales como caries dental, enfermedad periodontal, pérdida dentaria, lesiones en mucosa, cáncer bucal y xerostomía. Conclusiones: la tercera edad es una etapa en la cual las necesidades de salud se hacen cada vez más crecientes, debido fundamentalmente a los cambios fisiológicos y las enfermedades bucales que aparecen en el declinar de la vida.[AU]