Antecedente de trastorno mental en la UCI e interconsulta a psiquiatría / History of mental disorder in an ICU and referrals to psychiatry

Objetivo Determinar la prevalencia de pacientes con trastorno mental (TM) ingresados en la UCI. Comparar las características clínicas según la presencia de antecedentes psiquiátricos. Revisar la pertinencia de las interconsultas realizadas a psiquiatría. Diseño Estudio descriptivo retrospectivo. Ámbito UCI del Hospital General del Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España. Pacientes Pacientes ingresados entre enero de 2016 y junio de 2018. Intervenciones Ninguna. Variables de interés principales Nivel de gravedad (APACHEII), motivo de ingreso, días de ingreso, días de ventilación mecánica, antecedentes psiquiátricos y motivo de interconsulta a psiquiatría. Resultados Se incluyeron 1.247 pacientes; 194 (15,5%) cumplían criterios de TM, siendo su media de edad más joven (59 vs 68, p<0,001) y con menor puntuación media en la escala APACHEII (12 vs 14, p≤0,003). Se realizaron 64 interconsultas a psiquiatría (5,1% de los ingresos), 59 de las cuales fueron en pacientes con TM (92,1%). En cuanto a los motivos de la interconsulta, el 22,6% fueron por intento autolítico, el 61,3% para ajuste farmacológico, el 11,3% para descartar TM y el 4,8% para valoración de competencia. La posibilidad de que se realizara una interconsulta estando indicada fue del 89,1%, mientras que la posibilidad de no realizarla no estando indicada fue del 99,4%. Conclusiones Este estudio respalda la necesidad de ampliar las recomendaciones específicas para realizar interconsulta a psiquiatría, más allá de la valoración tras intento autolítico, puesto que un gran porcentaje (77,5%) de las interconsultas pertinentes fueron por otros motivos (AU)

Objective To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. Design Retrospective descriptive study. Setting ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. Patients Patients admitted between January 2016 and June 2018. Interventions None. Main variables of interest Severity level (APACHEII), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. Results A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P<.001) and with a lower mean score on the APACHEII scale (12 vs 14, P≤.003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. Conclusions This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons (AU)

History of mental disorder in an ICU and referrals to psychiatry.

OBJECTIVE: To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DESIGN: Retrospective descriptive study. SETTING: ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS: Patients admitted between January 2016 and June 2018. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Severity level (APACHE II), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS: A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P < .001) and with a lower mean score on the APACHE II scale (12 vs 14, P ≤ .003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. CONCLUSIONS: This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.

History of mental disorder in an ICU and referrals to psychiatry. / Antecedente de trastorno mental en la UCI e interconsulta a psiquiatría.

OBJECTIVE: To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DESIGN: Retrospective descriptive study. SETTING: ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS: Patients admitted between January 2016 and June 2018. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Severity level (APACHEII), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS: A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P<.001) and with a lower mean score on the APACHEII scale (12 vs 14, P≤.003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. CONCLUSIONS: This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.

Effect of magnetic ion exchange (MIEX®) on removal of emerging organic contaminants.

In this study, the removal of nine emerging organic contaminants was investigated by using anion exchange resins. The selected compounds were carbamazepine, atrazine, simazine, estrone, bisphenol A, methylparaben, ethylparaben, propylparaben and butylparaben. Two different magnetic anionic exchanger resins were tested: MIEX® DOC and MIEX® GOLD. The optimal resin dose (40 mL/L) and contact time (20 min) had been previously determined. Once these optimum parameters were set, the effect of the initial concentration of contaminants on the removal efficiency of the contaminants by the resins was studied. The study was carried out using mono and multicomponent systems, with distilled water and natural waters, to which contaminants had been previously added, in order to evaluate the competitive and matrix effects. Results showed that the average removal percentages obtained with the MIEX® DOC resin were: 51%, 61%, 68% and 80% for methyl-, ethyl-, propyl-, and butylparaben, respectively. For bisphenol A the result was similar, i.e., 66%, whereas for the rest of the compounds studied, removal efficiencies lower than 15% were obtained. The MIEX® GOLD resin achieved lower elimination rates than the MIEX® DOC resin in all cases.

Fertilidad posterior a la septoplastia histeroscópica de consultorio. Una propuesta de clasificación del septo uterino / Fertility after hysteroscopic septoplasty surgery. A proposed classification for the septum uterine

Resumen ANTECEDENTES: Las malformaciones müllerianas son anomalías del desarrollo de los genitales internos femeninos. La incidencia mundial es de 0.16 a 10%. La más común es el útero septado, consecuencia de una falla en la reabsorción del tabique útero-vaginal. OBJETIVO: Evaluar, en la población estudiada, la repercusión de la septoplastia histeroscópica en la fertilidad de mujeres con útero septado. MATERIALES Y MÉTODOS: Estudio abierto, observacional, retrospectivo y transversal de pacientes de la Clínica de Histeroscopia del Hospital General Dr. Manuel Gea González, con diagnóstico de infertilidad establecido con auxilio de la técnica de acceso por vaginoscopia, según Betocchi, siguiendo el concepto de "ver y tratar". RESULTADOS: Se revisaron 508 expedientes y de estos se seleccionaron 313 de pacientes a quienes se practicó histeroscopia diagnóstica de las que 32 resultaron con septo uterino. Se efectuaron 27 septoplastias histeroscópicas en consultorio y 5 programadas en quirófano. En 27 (84.3%) se logró el embarazo y de éstos 5 mediante fertilización asistida; hubo 8 nacimientos prematuros y 17 a término y 2 abortos diferidos. CONCLUSIÓN: Hoy día la septoplastia histeroscópica es la alternativa de tratamiento del septo uterino debido a su facilidad de realización en el consultorio por personal adiestrado, baja morbilidad, menores costos, rápida recuperación y excelente resultado reproductivo. Se propone una clasificación de acuerdo con el componente del septo.

Abstract BACKGROUND: Müllerian malformations are defined as anomalies development of female internal genitalia. Its incidence worldwide is 0.16% to 10%. The most common of these is the septate uterus which is due to a failure in the reabsorption of uterovaginal septum. OBJECTIVE: To evaluate the impact on fertility hysteroscopic septoplasty in women with uterine septum. MATERIAL AND METHODS: This is an open, observational, retrospective and cross-sectional study. 508 cases of which 313 patients underwent diagnostic office hysteroscopy hysteroscopy clinic were reviewed Hospital General Dr. Manuel Gea González, diagnosed with infertility, you access using the technique vaginoscopic according Betocchi, following the concept of" see and treat ", proceed to perform septoplasty with bipolar energy at that moment. RESULTS: 32 patients were diagnosed with uterine septum. 27 hysteroscopic septoplasty were performed in office and five scheduled in the operating room. 27 of them achieving pregnancy (84.38%) spontaneously regarding perinatal outcomes of those 27 patients who achieved pregnancy 2 had missed abortion, premature 8 were 17 were concluded; 5 required assisted fertilization. CONCLUSION: The hysteroscopic septoplasty is now recommended for the treatment of uterine septum due to ease of performance by trained personnel, low morbidity, the feasibility of its implementation in practice, reduced cost, speedy recovery of patients and excellent reproductive outcome alternative. Classification according to the component of the septum is proposed.

Alteraciones del sueño y síndrome de piernas inquietas en un adulto con síndrome de Asperger, a propósito de un caso / Sleep disorders and restless legs syndrome in an adult with Asperger’s disorder, a case report

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Paciente bipolar dual: un reto terapéutico / Dual diagnosis patient: a therapeutic challenge

Objetivo. Analizar el caso clínico de una paciente con trastorno bipolar y trastorno por uso de sustancias. Material y métodos. Se examina el caso clínico de una mujer de 50 años con diagnóstico de trastorno bipolar tipo II e historia de inestabilidad afectiva desde la adolescencia, que presenta consumo de benzodiacepinas con patrón de dependencia y de analgésicos con patrón de abuso, en el contexto de cefaleas de tipo migrañoso. Resultados. Se inicia la desintoxicación mediante el cambio de benzodiacepinas de vida media corta a otras de vida media larga. Posteriormente se inicia la reducción de la dosis, lenta y progresivamente. En el proceso, la paciente presenta diversos cuadros de desestabilización afectiva de predominio mixto, por lo que es necesario disminuir la pauta antidepresiva y demorar el descenso de la pauta benzodiacepínica. Se pospone la disminución de la pauta analgésica y se incluye en el programa de patología dual ambulatorio. Conclusiones. Las reagudizaciones del trastorno bipolar pueden dificultar el proceso de desintoxicación y deshabituación de sustancias, lo que es un problema habitual en los pacientes duales. La dependencia de benzodiacepinas y analgésicos puede enmascarar o modificar la sintomatología típica de los episodios maníacos o depresivos que la paciente pudiera tener en la evolución natural del trastorno bipolar. El diagnóstico dual implica, una mayor frecuencia de sintomatología mixta y una mayor predisposición al viraje a manía con antidepresivos, que en los pacientes bipolares no duales. Los pacientes bipolares duales deben ser evaluados y tratados con mucha precaución debido a las dificultades que habitualmente comporta su manejo (AU)

Objective. To analyze the case of a patient with bipolar disorder and substance use disorder. Material and methods. We evaluate the case of a 50-year-old woman with a diagnosis of bipolar disorder type II and a history of emotional instability from adolescence, who presented benzodiazepine dependence and abuse of analgesics in context of migraine headaches. Results. Detoxification process was started by changing the short half-life benzodiazepines to long half-life ones. Thereafter, the patient began a slow, gradual reduction in the use. During the process, the patient presented with various categories of affective destabilization of mixed dominance, which made it necessary to reduce the pattern of antidepressant and delay a greater drop in the standard benzodiazepines. Decrease of the analgesic dose was postponed and the patient was included in the out-patient dual diagnosis program. Conclusions. Bipolar relapses can hinder the process of detoxification and rehabilitation, which is a common problem in individual dual patients. Benzodiazepines and analgesics dependence or abuse can mask or modify typical manic symptoms or depressive episodes that the patient might have in the natural history of bipolar disorder. Dual diagnosis means a higher frequency of joint symptoms and a higher predisposition for switching to mania state with antidepressants than in non-dual bipolar patients. Patients with bipolar dual diagnosis must be evaluated and treated with great caution due to the difficulties that their management usually entails (AU)

Foot force direction in an isometric pushing task: prediction by kinematic and musculoskeletal models.

The abilities of a kinematic model and a muscle model of the human lower limb to predict the stereotyped direction of the muscular component of foot force produced by seated subjects in a static task were tested and compared. Human subjects ( n=11) performed a quasi-static, lower-limb pushing task against an instrumented bicycle pedal, free to rotate about its own axis, but with the crank fixed. Each pushing trial consisted of applying a force from the resting level to a force magnitude target with the right foot. Ten force target magnitudes were used (200, 250, ..., 650 N) along with 12 pedal positions. For each pushing effort, the muscular contribution to the measured foot force was determined from push onset to peak attained force. This segment was well characterized by a straight line across subjects, pedal positions, and force target magnitudes. The linear nature of the muscular component allowed a characteristic direction to be determined for each trial. A three-joint (hip, knee, and ankle) and a two-joint (hip and knee) net joint torque optimization was applied to a sagittal-plane kinematic model to predict the characteristic force direction. A musculoskeletal model was also used to create a feasible force space (FFS) for the lower limb. This FFS represents the range of possible forces the lower limb could theoretically produce. From this FFS, the direction of the maximum feasible foot force was determined and compared with the characteristic direction of subject performance. The muscle model proved to be the most effective in predicting subject force direction, followed by the three-joint and two-joint net joint torques optimizations. Similarities between the predictions of the kinematic and muscle model were also found.

Characteristics of the force applied to a pedal during human pushing efforts: emergent linearity.

The force seated humans exert on a translationally fixed pedal (foot force) may be directed at any angle because the fixed distance between the seat and the pedal axis kinematically constrains the lower limb. The authors' objective in the present work was to characterize such force. Participants (N = 7) generated force with their lower limb by pushing against the pedal in the most comfortable manner. Pushing efforts were repeated randomly 3 times at each of 97 sagittal-plane pedal axis positions and 10 additional times in 9 of those positions (2,895 total pushes). In 87% of the pushes, the measured sagittal-plane force exerted on the pedal by the foot changed magnitude and direction through time, such that the path of the head of the force vector traced a straight line. The linearity of the foot force paths reflected directional invariance in the changes of the foot force vector as the magnitude of the vector increased. The orientation of those linear force paths varied with limb posture in a similar manner across participants. The authors conclude that the emergent linearity of the force path is consistent with minimization of path length in foot force space. Alternatively, the linearity of the force paths suggests a motor control strategy that simplifies the control to a monoparametric form.

[Initial experience with a minidose of methotrexate in the management of unruptured ectopic pregnancy]. / Experiencia inicial con un esquema de minidosis única de metotrexate para el manejo de embarazo ectópico no roto.

Methotrexate has been used in the conservative management of ectopic pregnancy with good results. Due to its great afinity for the trophoblast it was decided to try unique doses of 50 mg i.m. independently of the body surface. Fifteen patients were studied with ectopic pregnancy by ultrasound and hCG in series that didn't require confirmatory laparoscopy. The ectopic pregnancies broken and/or decompensated were discarded. Average gestational age was 6.1 weeks; the maximal dimention of the sacs was 36.8 mm average; the values for hCG average were 6440 mU/ml and the maximal time of negativization was 52 days. One patient required laparoscopy and salpingostomy, lineal, for inminent rupture 24 hour after methotrexate, the other 14 presented with complete remission. There were no colateral effects. From the 15 patients, in 6 tubal permeability was confirmed by laparoscopy or HSG, being positive in 6 patients, it has not been evaluated, two patients with resolved pregnancy, and other on course (two of them with one salpinx). The proposed management seems to be useful in ectopic pregnancy with success, equivalent to surgical management, and other programs of medical management, with out side effects and with greater easiness of administration.

[Catheterization of the tubal ostium using hysteroscopy under laparoscopic guidance]. / Cateterización del ostium tubario bajo guía histeroscópica con control laparoscópico.

It is considered that one out of five couples present a transitory problem of infertility during their reproductive life and the most frequent cause is the tubarian pathology; from these, the proximal obstruction occupies between 25 and 30% of the cases. Unfortunatelly, the conventional method use to study tubarian patency such as histerosalpingography or the direct observation by laparoscopy and selective chromotubation, frequently do not allow to differentiate between an insufficient filling of the tubes, tubarian spasm or a true mechanical obstruction. There are certain selective tubarian cannulation techniques, for example, the catheterism with hysteroscopic guidance which is extremely usefull in the diagnosis of tubarian patency or in the confirmation of partial or total proximal tubal disease. The procedure permits to diagnosticate precisely the tubarian obstruction and also if it is due to the presence of a true pathology or simply functional, or secondary to a tubarian spasm; besides it also works as a therapeutic procedure since in the first case permits the lysis of laxe adherencies and the removal of the amorfus material that obstructs the tube and permits the catheterization. The present study determines the utility of catheterization of the tubarian ostium by hysteroscopy with laparoscopic control using the Novy (Cook, Ob/ Gyn) catheter in patients with infertility problems due to proximal obstruction of one or both of the fallopian tubes, to confirm or discard the presence of a pathological obstruction. The results are evaluated in terms of tubarian permeability and the pregnancy rate after the procedure.

[Laparoscopy and hysteroscopy in Müllerian duct malformations: usefulness and reproductive results]. / Laparoscopia e histeroscopia en malformaciones müllerianas: utilidad y resultados reproductivos.

Determine the type and the possibility of corrective surgery, reproductive results of infertility patients with Müllerian malformations. The clinic and the laparoscopic and hysteroscopic evaluation were performed to 40 patients with Müllerian anomalies and infertility history analyzing the reproductive results. The uterine septum was present in 23/40 patients (57.5%), bicornual uterus in 6/40 (15%), didelfus uterus 5/40 (12.5%), arcuate uterus 4/40 (10%), unicorn uterus 2/40 (5%). After septum resection we had 13 pregnancies (56.5%). 2 abortions, 4 already delivered and 7 continue normal evolution with on twin case. Strassman metroplasty by laparotomy was performed in 4 cases of bicornual uterus achieving pregnancy in two cases. In one didelfus uterus, a salpingoclasy of the smaller horn was done as an alternative. Of the arcuated uterus, the small septum was removed. Of the unicorn uterus, one pregnancy was lost in the first trimester and the other one reach the term date. Our data show that the endoscopic procedures can perform the correct diagnosis of the Müllerian anomalies and of course the best surgical treatment improving the fertility rates.

[Occurrence of pregnancy after microsurgical treatment of sterile patients with tubo-ovarian adhesive diseases]. / Frecuencia de embarazos después de tratamiento microquirúrgico en pacientes estériles por enfermedad adherencial tuboovárica.

In the last years, the adherence adnexal disease has been increased due to pelvic infections. This may cause infertility problems depending, of the nature, extension and localization inside the pelvis. In this paper we inform the results obtained in 70 patients with adnexal adhesions to whom it was performed a salpingo-ovariolysis with microsurgery technology, with the purpose of promote the fertility. All the patients received pre, trans and postoperative support (Heparin, steroids and antimicrobials). The minimal time of postoperative observation was at least 6 months. In 27 (Group I) of the 70 cases (38.6%), the adherences were avascular (IA & IIA based on Hulka's classification); and in the 43 patients of the group II (61.4%), the lesions were dense and vascular (IB & IIB). In group I, 15 pregnancies were obtained (55.6%), 13 at term, 1 miscarriage and 1 ectopic pregnancy; in the group II we documented 9 pregnancies (20.9%), 5 at term, 4 miscarriage (I trimester).

[Tubo-peritoneal factor. Endometriosis]. / Factor tuboperitoneal. Endometriosis.

Fifty cases of tuboperitoneal endometriosis with sterility, are reviewed. Laparoscopy was done in all the patients to confirm disease, and its severity was classified to AFS; 18 cases were of minimal endometriosis; 8 slight; 12 moderate; and 12 severe. The endometriotic profile in our environment is described and compared with which has been described in progresist countries; 32% of pregnancy at term, was obtained. The possible mechanisms producing sterility, are mentioned.

[Diagnostic and therapeutic management and results of the neuroendocrine factor in sterility]. / Conducta diagnóstica terapéutica y resultados del factor neuroendocrino en esterilidad.

One hundred and fifty patients with neuroendocrine alteration, mainly anovulation, proven by basal temperature and endometrial biopsy, were studied. Clinical history and basic examinations for sterility, were carried out. The neuroendocrine factor, alone or associated, was found in 35% of the patients studied for sterility. Primary sterility was 59.3% of the cases. The vagino-cervico-spermatic factor was the most frequent one associated to the neuroendocrine one (28%). Ovulation was induced in 62.6% of the cases. Pregnancy was achieved in 65 patients (43.3%; 80% reached term, and 20% were abortions.

[Lesions of the fallopian tube following tube occlusion]. / Lesiones de la trompa de Falopio posteriores a oclusión tubárica.

This is a study using light microscopy and electronic microscopy of Fallopian tube subjected to sterilization; and compare it with a control group. A total of 60 samples from patients with different surgical procedures, whose age was from 20 to 40 years; they were amenorrheic, without antecedents of pelvic inflammatory disease nor endometriosis. Among the control group, there were lesions as isthsmical nodular salpingitis in 30.7%. There was chronic salpingitis in 15.3%; follicular salpingitis in 23%, and polyps in 15%. In the group with OTB antecedents, endosalpingiosis was found in 20%; follicular salpingitis in 30% and chronic salpingitis in the remaining 50%. By means of electronic, ultrastructural microscopy, were seen lesions at myosalpinx level, that is, alterations in myofilaments, formation, much fibrosis and descilliation in the adjacent to OTB. It may be concluded that these findings, never seen before, may condition an alteration of tubal motility in patients subjected to rechannelization procedures, that condition an alteration in gametes transportation, avoiding fecundation or a greater incidence ectopic pregnancy incidence.