Indicaciones de la resonancia magnética en la lumbalgia de adultos / Indications for magnetic resonance imaging for low back pain in adults

Introducción: La lumbalgia genera numerosas consultas. La resonancia magnética (RM) es una opción diagnóstica en el manejo de alguno de estos pacientes. Sin embargo, su uso inadecuado supone una pérdida de recursos que obliga a disponer de guías que ayuden a los clínicos en la toma de decisiones y permita una mejor gestión de los recursos. Objetivo: Establecer las principales indicaciones clínicas de RM en los casos de dolor lumbar en adultos. Material y métodos: Se empleó el método de uso apropiado RAND/UCLA: tras una revisión sistemática en mayo de 2012 se elaboró un listado con posibles indicaciones de RM ante lumbalgia que un panel de expertos multidisciplinar puntuó desde 1, «totalmente inapropiado», a 9 «totalmente apropiado». Se realizó una primera ronda de puntuación online, se presentaron y discutieron los resultados en una reunión presencial y se realizó una ronda final online. La RM se consideró apropiada en cada indicación si la puntuación mediana era de 6,5 o mayor y había acuerdo (empleando el índice IPRAS). Resultados: La RM se consideró apropiada ante sospecha afectación tumoral, sospecha de infección espinal, sospecha de fractura a pesar de radiografía negativa, lumbalgia con dolor de ritmo inflamatorio, déficit neurológico progresivo/grave, dolor muy severo y que progresa de intensidad y lumbalgia subaguda o crónica con irradiación radicular con fracaso en el tratamiento. Conclusiones: La indicación de RM parece basarse en la sospecha de enfermedad grave secundaria. La metodología empleada permite establecer indicaciones de RM que pueden ser de utilidad tanto al clínico como al gestor sanitario (AU)

Introduction: Low back pain is a common disorder that generates many medical consultations. Magnetic Resonance Imaging (MRI) is commonly used in the clinical management of some of these patients. However, the cost of inappropriate MRI use is high, so there is a need to develop guidelines to help physicians make correct decisions and optimize available resources. Objective: To determine the main clinical indications for MRI scanning in adults with low backpain. Material and methods: The RAND/UCLA appropriateness method was used: After a systematic review (May 2012), a list of the clinical indications for MRI scanning in patients with low back pain was prepared. A multidisciplinary expert panel scored each indication from 1, «totally inappropriate» to 9,«totally appropriate». A first on-line round, an in-person panel meeting, where results of the first round were discussed, and a final second on-line round were arranged. A clinical indication was considered appropriate if the median score was 6.5 or higher, and there was agreement between experts (IPRAS index was used). Results: An MRI test is considered appropriate if cancer, spinal infection or a fracture, even with a negative X-ray test is suspected.; if there is inflammatory back pain; severe/progressive neurological deficit; severe and progressive low back pain; subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy. Conclusions: Clinical indications for a MRI scanning are based on the suspicion of a secondary serious pathology. This methodology helps to set clinical indications for MRI, and may be of great value for both clinicians and health managers (AU)

[Indications for magnetic resonance imaging for low back pain in adults]. / Indicaciones de la resonancia magnética en la lumbalgia de adultos.

INTRODUCTION: Low back pain is a common disorder that generates many medical consultations. Magnetic Resonance Imaging (MRI) is commonly used in the clinical management of some of these patients. However, the cost of inappropriate MRI use is high, so there is a need to develop guidelines to help physicians make correct decisions and optimize available resources. OBJECTIVE: To determine the main clinical indications for MRI scanning in adults with low back pain. MATERIAL AND METHODS: The RAND/UCLA appropriateness method was used: After a systematic review (May 2012), a list of the clinical indications for MRI scanning in patients with low back pain was prepared. A multidisciplinary expert panel scored each indication from 1, «totally inappropriate¼ to 9, «totally appropriate¼. A first on-line round, an in-person panel meeting, where results of the first round were discussed, and a final second on-line round were arranged. A clinical indication was considered appropriate if the median score was 6.5 or higher, and there was agreement between experts (IPRAS index was used). RESULTS: An MRI test is considered appropriate if cancer, spinal infection or a fracture, even with a negative X-ray test is suspected.; if there is inflammatory back pain; severe/progressive neurological deficit; severe and progressive low back pain; subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy. CONCLUSIONS: Clinical indications for a MRI scanning are based on the suspicion of a secondary serious pathology. This methodology helps to set clinical indications for MRI, and may be of great value for both clinicians and health managers.

Indicación de resonancia magnética ante cefalea en adultos: resultados siguiendo el método RAND/UCLA de uso apropiado / Indication of magnetic resonance imaging in cases of headaches in adults: results following the RAND/UCLA appropriateness method

Introducción. El número de peticiones de resonancia magnética (RM) en los sistemas sanitarios es cada vez mayor. La RM craneal es una de las localizaciones más frecuentes, cuya mala utilización supone una pérdida de recursos, lo que obliga a disponer de guías que ayuden a los clínicos en la toma de decisiones y permita una mejor gestión de los recursos. Objetivo. Establecer las principales indicaciones de RM en los casos de cefalea en adultos. Materiales y métodos. Se utilizó el método de uso apropiado RAND/UCLA: tras una revisión sistemática se elaboró un listado con posibles indicaciones de RM ante cefalea que un panel de expertos puntuó del 1 (‘totalmente inapropiado’) al 9 (‘totalmente apropiado’). Se realizó una primera ronda de puntuación online, luego se presentaron y se discutieron los resultados en una reunión presencial y se emprendió una ronda final online. La RM se consideró apropiada en cada indicación si la puntuación mediana era de 6,5 o mayor y había acuerdo (empleando el índice IPRAS). Resultados. La RM se consideró apropiada ante: nueva cefalea, nueva cefalea en paciente inmunodeprimido, cefalea intensa súbita, cefalea con sintomatología neurológica focal, cefalea postural, cefalea por esfuerzo físico o maniobras de Valsalva, sospecha de trombosis del seno venoso, afectación sistémica, cefalea progresiva, cefalea en embarazada, cefalalgia trigeminal autonómica o traumatismo craneal grave con focalidad. Conclusiones. La indicación parece resumirse en cefaleas con sospecha de patología secundaria. La metodología empleada permite establecer indicaciones de RM que pueden ser de utilidad tanto para el clínico como para el gestor sanitario (AU)

Introduction. The number of requests for magnetic resonance imaging (MRI) scans in healthcare systems is continually on the rise. An MRI scan of the head is one of the most frequent locations, which if used inappropriately entails a loss of resources. Consequently, guidelines are needed to help the physician make decisions and allow better management of resources Aim. To establish the key indications of MRI scans in cases of adults with headache. Materials and methods. The RAND/UCLA appropriateness method was used, that is, following a systematic review, a list of possible indications of MRI in cases of headache was drawn up. This list was then assessed by a panel of experts and given a score between 1 (‘totally inappropriate’) and 9 (‘totally appropriate’). An initial round of scoring was carried out online, the results were then discussed at a face-to-face meeting of the experts and finally another online round was undertaken. MRI was considered appropriate in each indication if the mean score was 6.5 or higher and there was agreement among the experts (using the IPRAS index).Results. MRI scanning was considered appropriate in cases of: new headache, new headache in immunodeficient patients, sudden intense headache, headache with focal neurological symptoms, postural headache, headache due to physical effort or Valsalva manoeuvres, suspected thrombosis in the venous sinuses, systemic involvement, progressive headache, headache in pregnancy, autonomic trigeminal headache or severe cranial traumatic injury with focus. Conclusions. It seems that indication can be summed up in headaches with a suspected secondary pathology. The methodology employed makes it possible to establish MRI indications that can be useful both in clinical practice and for healthcare management practitioners (AU)

[The immunogenicity of vaccines against diphtheria, tetanus, pertussis and polio administered orally on the vaccinal calendar at the age of 2, 4 and 6 months and their coadministration with a hepatitis B vaccine at 0, 2 and 6 months]. / Inmunogenicidad de las vacunas contra la difteria, tétanos, pertusis y polio oral administradas en el calendario vacunal a la edad de 2, 4 y 6 meses y en su coadministración con la vacuna contra la hepatitis B a los 0, 2 y 6 meses.

The immunogenicity of oral diphtheria, pertussis, tetanus, (DPT) and polio vaccines was examined. Six hundred seventy-seven children (Group I) were given hepatitis B vaccine at 0, 2, and 6 months of age and the oral DPT-polio vaccines were administered at 2, 4 and 6 months of age. A control group of 731 children (Group II) received only oral DPT-polio vaccines. In both groups the vaccine efficacy against poliomyelitis was 96% for serotype I and 100% for serotype II. For serotype III, the vaccine efficacy was 98% and 97% for groups I and II, respectively. In both groups 97% of the children had antibodies against B. pertussis and all children were positive for tetanus and diphtheria. No immune interference between the oral DPT and polio vaccines and the hepatitis B vaccine when they were given simultaneously could be demonstrated as the immune response to the DPT and polio vaccines were identical in both groups. It can be concluded that the simultaneous administration of the hepatitis B vaccine with the DPT and polio vaccines did not interfere with the immune response to the other antigens.

[Prevalence of hepatitis B infection in institutions for the mentally retarded. Epidemiologic characteristics in the province of Vizcaya]. / Prevalencia de infección por el virus de la hepatitis B en instituciones de deficientes mentales. Características epidemiológicas en la provincia de Vizcaya.

The prevalence of hepatitis B virus (HBV) infection was studied in 346 subjects (148 employees and 198 mentally retarded) in four institutions for the mentally subnormal in Vizcaya-Spain. The prevalence of markers in the overall group was 32.6%; 13.5% in the employees and 46.9% in the mentally retarded. Early age and institutionalization time increases the risk of infection in the mentally retarded group, but not in the employees group. 220 subjects (118 employees and 102 mentally retarded) had negative HBV markers and were vaccinated with recombinant-DNA hepatitis B vaccine. The immunogenicity was 80% and the weight-height index the only factor implicit in the group of subjects no seroconverters. The reactogenicity of vaccine was 6.7%.