[Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital]. / Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel.

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting.

Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry. / Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC.

OBJECTIVE: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. METHODS: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. RESULTS: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). CONCLUSIONS: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.

Asociación entre el síndrome de movilidad articular limitada y el riesgo de caídas accidentales en pacientes diabéticos / Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients

Introducción: El síndrome de movilidad articular limitada (SMAL) aparece exclusivamente en pacientes con diabetes, tanto tipo 1 como tipo 2. Se manifiesta como una limitación en la movilidad articular que inicialmente afecta a las falanges proximales de las manos, seguidas, por orden de frecuencia, por muñecas, codos, hombros, rodillas y esqueleto axial. El diagnóstico se puede realizar mediante pruebas sencillas, como «el test de la oración». El objetivo fue conocer la prevalencia de pacientes diabéticos con SMAL, evaluar la asociación entre el SMAL y el grado de control glucémico y el riesgo de caídas accidentales. Pacientes y métodos: Estudio observacional transversal en el Centro de Salud de San Fernando II, Madrid (periferia). La muestra fueron 184 pacientes con un diagnóstico de diabetes superior a 5 años entre noviembre-marzo de 2013. Se utilizó el test de la oración para evaluar si los pacientes presentaban SMAL. El riesgo de caídas fue determinado según el test Timed Up & Go. Resultados: Un total de 99 pacientes (53,8%) (IC 95% 46,6-61) presentaron un test de la oración positivo. No se obtuvo una relación estadísticamente significativa con la HbA1c, en cambio, sí que se vio una asociación entre el test Timed Up & Go y el SMAL (p < 0,001) (IC 95% 1,173-1,611). Los pacientes con SMAL presentaban un riesgo moderado de caídas frente a aquellos sin SMAL, que presentaban un riesgo bajo. Conclusiones: Existe una alta prevalencia de SMAL en nuestro medio. Presentamos el primer estudio en donde se relaciona el SMAL con el riesgo de caídas en los pacientes diabéticos (AU)

Introduction: Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple «prayer sign» test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. Patients and methods: A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. Results: A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P < .001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. Conclusions: The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients (AU)

[Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients]. / Asociación entre el síndrome de movilidad articular limitada y el riesgo de caídas accidentales en pacientes diabéticos.

INTRODUCTION: Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. PATIENTS AND METHODS: A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. RESULTS: A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. CONCLUSIONS: The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients.

Hipertensión intracraneal benigna y colitis ulcerosa / Benign intracranial hypertension and ulcerative colitis

No disponible

[Burden of hospitalizations attributable to rotavirus infection in children in the Autonomous Region of Madrid, Spain, period 1999-2000]. / Ingresos hospitalarios atribuibles a rotavirus en niños de la Comunidad de Madrid, período 1999-2000.

OBJECTIVE: To assess rotavirus infection requiring hospitalization in children aged < or = 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain). MATERIAL AND METHOD: A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Mínimo Básico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Información Microbiológica [SIM]). CMBD data for all hospital admissions in children aged < or = 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed. RESULTS: The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged < or = 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged (3/4) 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %. CONCLUSIONS: Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged < or = 5 years in the Autonomous Region of Madrid.

Ingresos hospitalarios atribuibles a rotavirus en niños de la Comunidad de Madrid, período 1999-2000 / Burden of hospitalizations attributable to rotavirus infection in children in the Autonomous Region of Madrid, Spain, period 1999-2000

Objetivo Estudiar las hospitalizaciones atribuibles a infecciones por rotavirus en niños de hasta 5 años durante el período 1999-2000 en la Comunidad de Madrid. Material y método Estudio retrospectivo, utilizando como fuentes de información la base de datos hospitalaria Conjunto Mínimo Básico de Datos (CMBD) y el Sistema de Información Microbiológica (SIM). Se analizaron los datos del CMBD correspondientes a hospitalizaciones en niños de hasta 5 años con un diagnóstico principal al alta de enfermedad intestinal infecciosa (códigos CIE-9-MC 001-009) o gastroenteritis no infecciosa (código CIE-9-MC 558) y las notificaciones al SIM de los principales patógenos causantes de gastroenteritis aguda. Resultados La incidencia anual de hospitalizaciones por gastroenteritis aguda fue de 69 casos por 10.000 niños de hasta 5 años. El 14 % de los 32.541 casos de infección producidos por patógenos responsables de gastroenteritis agudas notificados al SIM fueron producidos por rotavirus. La proporción de casos de infección por rotavirus confirmada en laboratorio, extrapolada al número de hospitalizaciones por gastroenteritis aguda da como resultado una incidencia anual de hospitalizaciones atribuibles a rotavirus de 12 casos por 10.000 niños de hasta 5 años. La estancia media hospitalaria fue de 4,0 días, el número medio anual de días de hospitalización fue de 1.382 días y el coste de 565.907 euros. El exceso de hospitalizaciones durante los meses epidémicos para rotavirus (diciembre y enero) fue del 67 %. Conclusiones El rotavirus ocasiona una parte importante de los ingresos hospitalarios por gastroenteritis aguda en niños de hasta 5 años en la Comunidad de Madrid

Objective To assess rotavirus infection requiring hospitalization in children aged <= 5 years between 1999 and 2000 in the Autonomous Region of Madrid (Spain). Material and method A retrospective study was conducted, based on the hospital data surveillance system (Conjunto Mínimo Básico de Datos [CMBD]) and on the Spanish national microbiological information system (Sistema de Información Microbiológica [SIM]). CMBD data for all hospital admissions in children aged <= 5 years with a first-listed diagnosis of intestinal infectious disease (ICD-9-CM codes: 001-009) or non-infective gastroenteritis (ICD-9-CM code: 558) and the reports to the SIM of the major pathogen groups responsible for acute gastroenteritis were analyzed. Results The annual incidence of hospitalizations for acute gastroenteritis was 69 cases per 10,000 children aged ≤ 5 years. Fourteen percent of the 32,541 infections produced by pathogens responsible for acute gastroenteritis reported to the SIM were rotavirus. The estimated annual incidence of hospitalizations due to rotavirus infections was 12 cases per 10,000 children aged ¾ 5 years. The mean length of stay was 4.0 days, the annual mean number of days of hospitalization was 1,382 days, and the annual cost was 565,907 J. During the rotavirus epidemic months (December and January), the percentage of excess hospitalizations was 67 %. Conclusions Rotavirus causes a significant proportion of hospital admissions due to acute gastroenteritis in children aged ≤ 5 years in the Autonomous Region of Madrid

Hallazgo incidental de arteria subclavia derecha aberrante / Incidental finding of aberrant right subclavian artery

No disponible

[Assessment of Machiavellian intelligence in antisocial disorder with the MACH-IV Scale]. / Valoración de la Inteligencia maquiavélica en el trastorno antisocial mediante la Escala MACH-IV.

INTRODUCTION: The objective is to evaluate the presence of Machiavellian intelligence with the MACH-IV Scale in antisocial patients versus community controls. MATERIAL AND METHODS: Categorical diagnosis and dimensional evaluation program according to IPDE were obtained from 26 controls from the community and 40 patients from a methadone program. Both groups were evaluated on cooperation with TCI and on Machiavellian intelligence with MACH-IV. RESULTS: Higher figures in MACH-IV Global Score, Tactics subscale (to manipulate others), Visions subscale (interpretations on Machiavellian behavior of others) were found in the 20 antisocial patients compared with the 26 community controls achieving statistical significance. No statistical differences were found for Morality subscale scores (abstract morality) between groups. Dimensional evaluation of antisocial disorder according to IPDE shows statistically significant positive correlations for Tactics subscale, Visions subscale and Global Score of MACH-IV scale, but no statistically significant correlation was found for Morality subscale. There is a statistically significant negative correlation between MACH-IV Tactics subscale and TIC altruism subscale. CONCLUSIONS: Antisocial patients have the same level of abstract moral attitudes as controls but are prone to use Machiavellian intelligence to interpret the actions of others, rationalize their own conduct and manipulate the behavior of others to get a benefit. These data support the hypothesis that many of the features of the antisocial syndrome may be explained by an abnormal development of an innate predisposition to be dominant in social relationships.

Valoración de la inteligencia maquiavélica en el trastorno antisocial mediante la Escala MACH-IV / Assessment of Machiavellian intelligence in antisocial disorder with the MACH-IV Scale

Introducción. El objetivo es valorar la presencia de inteligencia maquiavélica mediante la escala MACH-IV en pacientes antisociales frente a controles de la comunidad. Material y métodos. A 26 controles de la comunidad y 40 pacientes de un programa de metadona se les valoró la presencia dimensional y categorial de trastornos de personalidad mediante la IPDE, la cooperación según la subescala del TU y la inteligencia maquiavélica mediante la escala MACH-IV. Resultados. De forma estadísticamente significativa los 20 pacientes antisociales del programa de metadona comparados con los 26 controles tienen mayores puntuaciones en la puntuación total de la Escala MACH-IV, la subescala Tácticas (para manipular a otras personas) y la subescala Visiones (interpretaciones sobre la conducta maquiavélica de otros). No hay diferencias para la subescala Moralidad (moralidad abstracta). La valoración dimensional del trastorno antisocial según IPDE presenta correlaciones positivas de forma estadísticamente significativa para las subescalas Tácticas, Visiones y Puntuación Total (pero no para la subescala Moralidad). Existe una correlación negativa estadísticamente significativa entre la subescala Tácticas del MACH-IV y la de altruismo del TCI. Conclusiones. Los pacientes antisociales no difieren en sus actitudes morales abstractas con respecto a los controles pero tienen una mayor tendencia a usar los postulados de la Teoría de la Inteligencia Maquiavélica a la hora de interpretar las acciones de los otros, justificar las propias acciones así como para manipular la conducta de otros para obtener beneficio. Estos resultados apoyan la hipótesis de que muchos rasgos del trastorno antisocial pueden deberse a un desarrollo anormal de las predisposiciones innatas a ser dominante en la relación social (AU)

[Antisocial personality disorder evaluation with the prisoner's dilemma]. / Evaluación del trastorno antisocial de personalidad con el dilema del prisionero.

INTRODUCTION: The aim of this study is to evaluate cooperation problems in antisocial disorder with the prisoner's dilemma game, which, in mathematical game theory, is the paradigm of the <> games (mutual benefit from cooperation). METHODS: We have designed a computer version of the prisoner's dilemma (CDT-BD) that confronts the patient to a simulation of a reciprocal exchange situation. IPDE provided us a categorical and dimensional evaluation of 26 controls from the community and 40 methadone patients. Only methadone patients obtained an antisocial diagnosis: 20 in the category of positive antisocial and 10 in the probable antisocial category. Patients also fullfilled TCI and MACH-IV. RESULTS: CDT-BD is, according to the parent's opinion (mothers), a good correlation of real life behavior. CDT-BD shows a statistically significant poorer cooperation of antisocial patients this is catego rical evaluation (ve rsus in controls) and in dimensional evaluation true both for variables that measure non-cooperation due to the patient's initiative and those as a response to the computer provocation. This may be due to a tendency of antisocials to use interchange situations <> strategies (you win what the other player loses) instead of non-zero games strategies. Non-cooperative responses are correlated to high scores on the MACH-IV scale (manipulative behavior and cognition) and revengeful in Treatment and Character Inventory (TCI). CONCLUSIONS: CDT-BD allows us to generate and test new hypotheses on the causes of the cooperation problems in antisocial patients using game theory paradigms.

Evaluación del trastorno antisocial de personalidad con el dilema del prisionero / Antisocial personality disorder evaluation with the prisoner's dilemma

Introducción. El objetivo de este estudio es investigar los problemas de cooperación de los pacientes antisociales, usando el "dilema del prisionero", paradigma en la teoría matemática de juegos del grupo de juegos llamados "no suma cero" (mutuo beneficio en la cooperación). Métodos. Para ello diseñamos una versión del test del dilema por ordenador para la evaluación de los trastornos de conducta (TDO-TC) que pusiera al paciente en una simulación del prisionero por ordenador para un intercambio recíproco. Se valoró la presencia de trastornos de personalidad dimensional y categorialmente con la entrevista International Parmality Disorders Examination (IPDE) en 26 controles de la comunidad y en 40 pacientes de un programa de metadona. Sólo en el grupo de metadona se obtuvieron diagnósticos de trastorno de personalidad antisocial: 20 pacientes en grado de diagnóstico positivo y 10 en grado de diagnóstico probable .Los pacientes también rellenaron el Temperament and Character Inventory (TCI) y el MACH- IV. Se correlacionaron resultados con conducta en la vida real. Resultados. El TDO-TC es según familiares (madres) de los pacientes un reflejo fiel de la conducta real. A nivel estadisticamente significativo el TDO-TC muestra menor cooperación en la valoración categorial ( versus controles) y dimensional del trastorno antisocial, ya sea para variables que miden no cooperación por iniciativa del paciente o como respuesta a una provocación del ordenador. Esto se debe probablemente al uso en esta situación de estrategias propias de juegos tipo "suma cero" (el beneficio de un jugador es a costa de las pérdidas del otro). Las respuestas no cooperadoras se asocian a altas puntuaciones en las escalas MACH-IV (conducta y actitudes manipulativas o maquiavélicas) y ser vengativo en el TCI.Conclusiones. El TDO-TC nos permite generar y verificar nuevas hipótesis sobre el origen de los problemas de cooperación en los pacientes antisociales a partir de la teoría de juegos. (AU)

[Intestinal tuberculosis. A diagnostic challenge]. / Tuberculosis intestinal. Un reto diagnóstico.

Tuberculosis (TB) is a common disease in Spain, whose incidence has increased due to AIDS, immunotherapy and immigration. Intestinal disease is rare and can be difficult to diagnose because its symptoms and laboratory results are nonspecific. In addition, endoscopic lesions resemble those of other diseases such as Crohns disease (CD). Differentiating between intestinal TB and CD is very important since steroid treatment con be life saving in CD and lethal in intestinal TB. Colonoscopy plays an important role in establishing a suspected diagnosis. The endoscopic findings most characteristic of intestinal TB are circular ulcers, small diverticula (3-5 mm), and sessile firm polyps. The suspected diagnosis must be confirmed by the presence of caseating granulomas and/or acid fast bacilli. Polymerase chain reaction is currently recommended for assessing the presence of tubercle bacilli in tissue specimens obtained by endoscopic biopsy. We report a case of intestinal TB in a female renal transplant recipient that demonstrates the difficulty of making this diagnosis.

Principles of biotechnological treatment of industrial wastes.

This review includes current information on biodegradation processes of pollutants, digestor biocenosis and bioadditives, sludge production, measurement of pollution, and advances regarding biotechnological treatment of a series of specific industrial effluents.

Influence of sex, age, and menopause in serum osteocalcin (BGP) levels.

Osteocalcin (bone Gla protein) is a promising marker of bone turnover useful in the diagnosis and follow-up of high turnover osteoporosis. Conflicting results have been reported about its physiological variations according to sex, age, and menopause. Several, but not all, authors have found increased levels in males, with aging, and after menopause. We measured serum osteocalcin in 126 healthy subjects, 57 males and 69 females, aged between 45 and 88 years. Osteocalcin was higher (P less than 0.01) in males (6.24 +/- 0.36) than in females (4.32 +/- 0.34). This sexual difference was significant, too, in subjects younger and older than 60 years. Osteocalcin increased with age, linearly in males (P less than 0.05), and exponentially in females (P less than 0.05). Although there was a difference in age (P less than 0.05), no difference in osteocalcin levels between premenopausal women and women in their first two postmenopausal years was detected, while osteocalcin was significantly increased in women more than two years into menopause. We conclude that osteocalcin in healthy subjects is higher in males than in females and increases with age after 45 years in both sexes. Osteocalcin levels increase in women more than two years beyond menopause, but not only as an effect on aging.

[The identification of plasma calcitonin in liver cirrhosis]. / Identificacón de la calcitonina plasmática en la cirrosis hepática.

Increased levels of plasmatic calcitonin (PC) have been found in patients afflicted with liver cirrhosis (LC). Different circulating polypeptides of calcitonin with contrasting molecular weight (MW) have been observed by way of several methods of identification. The aim of our study is identify these types of PC in patients afflicted with LC, using a gel chromatography technique, comparing them with those obtained from patients with thyroid medullar carcinoma (TMC). A first PC peak with MW of 30,000 daltons (D) corresponding to macromolecular types of PC of LC was observed. Furthermore, a second peak of PC, corresponding to a synthetic human calcitonin and to monomers of PC in patients with TMC was noted. This indicates is a slight increase of monomeric PC in patients with LC, although its biological function is unknown.