Association between oocyte donors' or recipients' body mass index and clinical outcomes after first single blastocyst transfers-the uterus is the most affected.

OBJECTIVE: To assess whether high body mass index (BMI) in either oocyte donors or recipients is associated with poorer outcomes after the first single blastocyst transfer. DESIGN: Retrospective study including 1,394 first blastocyst single embryo transfers (SETs) conducted by 1,394 recipients during oocyte donation cycles with the gametes retrieved from 1,394 women (January 2019-July 2021). Four BMI clusters were defined for both donors and recipients (underweight: <18.5 kg; normal weight: 18.5-24.9 kg; overweight: 25-29.9 kg; and obese: ≥30 kg). SETTING: Network of private IVF centers. PATIENTS: A total of 1,394 recipients aged 42.4 ± 4.0 and with a BMI of 23.2 ± 3.8 kg/m2, and 1,394 donors aged 26.1 ± 4.2 and with a BMI of 21.9 ± 2.5 kg/m2. INTERVENTION: All oocytes were vitrified at 2 egg banks and warmed at 8 in vitro fertilization clinics that were part of the same network. Intracytoplasmic sperm injection, blastocyst culture, and either fresh or vitrified-warmed SETs were conducted. Putative confounders were investigated, and the data were adjusted through regression analyses. MAIN OUTCOME MEASURES: The primary outcome was the live birth rate (LBR) per SET according to donors' and/or recipients' BMI. The main secondary outcome was the miscarriage rate (<22 gestational weeks) per clinical pregnancy. RESULTS: The LBR per blastocyst SET showed no significant association with donors' BMI. Regarding recipients' BMI, instead, the multivariate odds ratio was significant in obese vs. normal-weight recipients (0.58, 95% confidence interval, 0.37-0.91). The miscarriage rate per clinical pregnancy was also significantly associated with recipients' obesity, with a multivariate odds ratio of 2.31 (95% confidence interval, 1.18-4.51) vs. normal-weight patients. A generalized additive model method was used to represent the relationship between predicted LBR or miscarriage rates and donors' or recipients' BMI; it pictured a scenario where the former outcome moderately but continuously decreases with increasing recipients' BMI to then sharply decline in the BMI range of 25-35 kg/m2. The miscarriage rate, instead, increases almost linearly with respect to both donors' and recipients' increasing BMI. CONCLUSION: Obesity mostly affects the uterus, especially because of higher miscarriage rates. Yet, poorer outcomes can be appreciated already with a BMI of 25 kg/m2 in both oocyte donors and recipients. Finer markers of nutritional homeostasis are therefore desirable; recipients should be counseled about poorer expected outcomes in cases of overweight and obesity; and oocyte banks should avoid assigning oocytes from overweight donors to overweight and obese recipients.

Dynamic assessment of human sperm DNA damage III: the effect of sperm freezing techniques.

Among the currently available strategies for sperm freezing, vitrification may be considered as the leading alternative to conventional cryopreservation. Nevertheless, a direct comparison of both techniques with respect to the iatrogenic sperm DNA damage has not been performed yet. As such, this study was focused to assess the static and dynamic behavior of human sperm DNA damage following thawing of cryopreserved or vitrified spermatozoa. Semen samples were obtained from fifty donors with a normal spermiogram, and divided into four aliquots. The first aliquot represented the neat sample. In the second aliquot the seminal plasma was discarded, and the resulting sperm pellet was resuspended in PBS. The third fraction was used for slow freezing and the fourth fraction was subjected to vitrification. Each set of samples was incubated at 37 °C for 24 h and sperm DNA damage (SDF) was assessed using the chromatin-dispersion test following 0 h, 2 h, 4 h and 24 h of incubation. When comparing the rate of DNA fragmentation (r-SDF) at 2 h, significant differences were observed between the PBS group, cryopreserved (p .000) or vitrified semen (p .015). Furthermore, the sperm longevity comparison using Kaplan-Meier survival curves revealed significant differences between cryopreservation and vitrification (p .000). Our data suggest that exposure of spermatozoa to low temperatures, independently of the chosen freezing protocol, leads to a higher susceptibility of sperm DNA towards damage. This damage is nevertheless lower following vitrification in comparison to traditional cryopreservation. As vitrification leads to a smaller proportion of spermatozoa with DNA damage, we may recommend its use in reproductive techniques which rely on a longer sperm survival, such as artificial insemination.

Relación entre la infección por el virus del papiloma humano y Chlamydia trachomatis / Relationship between human papillomavirus infection and Chlamydia trachomatis

La infección persistente por el virus del papiloma humano (VPH) es un requisito necesario pero no suficiente para el desarrollo del cáncer de cuello uterino (CCU), puesto que solo una baja proporción de las pacientes infectadas desarrolla una lesión intraepitelial cervical o un CCU. Esto hace pensar que son necesarios algunos cofactores que favorezcan dicha progresión. Según varios estudios, la infección por Chlamydia trachomatis (CT) es más prevalente en las pacientes con infección por VPH y parece que puede influir en la progresión de las lesiones epiteliales producidas por el VPH, relacionándose así de forma indirecta con el CCU. El cribado de la infección por CT y el correcto tratamiento de los casos permitiría evitar las consecuencias derivadas de la propia infección (salpingitis, EIP, esterilidad…) y la influencia que ejerce en el desarrollo del cáncer de cérvix

Human papillomavirus (HPV) infection is required but not sufficient to develop cervical cancer, since only a small proportion of HPV-infected women develop cervical intraepithelial lesions or cancer. This leads to the conclusion that other factors are required to facilitate disease progression. According to several studies, Chlamydia trachomatis (CT) infection is more prevalent in HPV-infected women and seems to contribute to the progression of HPV-related epithelial lesions. It is therefore indirectly related to cervical cancer. CT infection screening and the proper treatment of this condition could avoid the consequences of this genital infection (salpingitis, pelvic inflammatory disease, infertility, etc.) and its impact on developing cervical cancer

Fine processes of Nestin-GFP-positive radial glia-like stem cells in the adult dentate gyrus ensheathe local synapses and vasculature.

Adult hippocampal neurogenesis relies on the activation of neural stem cells in the dentate gyrus, their division, and differentiation of their progeny into mature granule neurons. The complex morphology of radial glia-like (RGL) stem cells suggests that these cells establish numerous contacts with the cellular components of the neurogenic niche that may play a crucial role in the regulation of RGL stem cell activity. However, the morphology of RGL stem cells remains poorly described. Here, we used light microscopy and electron microscopy to examine Nestin-GFP transgenic mice and provide a detailed ultrastructural reconstruction analysis of Nestin-GFP-positive RGL cells of the dentate gyrus. We show that their primary processes follow a tortuous path from the subgranular zone through the granule cell layer and ensheathe local synapses and vasculature in the inner molecular layer. They share the ensheathing of synapses and vasculature with astrocytic processes and adhere to the adjacent processes of astrocytes. This extensive interaction of processes with their local environment could allow them to be uniquely receptive to signals from local neurons, glia, and vasculature, which may regulate their fate.

La medida de la capacidad reflexiva: instrumentos disponibles en castellano y tareas pendientes / The measurement of reflective capacity: instruments available in spanish and pending tasks

Introducción: La medida de la función reflexiva se ha convertido en un aspecto central para la evaluación e investigación de procesos en psicoterapia. Material y método: Se realizó una revisión sistemática de los instrumentos propuestos para la medida de la función reflexiva, actualizando la realizada por Luyten en el año 2011. Se realizó también una revisión de los instrumentos validados en lengua castellana. Resultados: Se encontraron cuestionarios, entrevistas, pruebas experimentales y proyectivas indicadas para la medida de función reflexiva. Conclusiones: En el momento actual faltan instrumentos validados en castellano para poder realizar investigaciones en este campo. Por esta razón, se hacen recomendaciones sobre formación de evaluadores, la puesta a prueba de instrumentos ya validados en muestras clínicas y la validación de instrumentos no disponibles en castellano (AU)

Introduction: The measurement of reflective functioning has become a centralaspect for evaluation and processes investigation in psychotherapy. Material and method: A systematic review of the proposed instruments for measuring reflective functioning was performed, updating that one realized by Luyten in 2011. A review of validated instruments in Spanish was also performed. Results: Questionnaires, interviews, experimental and projective tests indicated for the measurement of reflective functioning were found. Conclusions: At the current time, instruments validated in Spanish are absent to be able to perform investigations in this field. For this reason, recommendations for evaluators training, testing validated instruments in clinical samples and validation of non-available instruments in Spanish are performed (AU)

Hematoma de mama que simula un cáncer y cáncer de mama que debuta con hematoma / Breast hematoma mimicking carcinoma and breast carcinoma presenting as a hematoma

Algunas lesiones benignas de la mama, como los hematomas, pueden presentarse en la mamografía como lesiones espiculadas y mal definidas sugestivas de malignidad y, por otro lado, lesiones malignas ocultas pueden producir un sangrado y presentarse clínicamente como hematomas de mama. Presentamos el caso de una paciente con una lesión mamográfica sugestiva de carcinoma y en la que los estudios posteriores revelaron la presencia de un hematoma de mama y el caso de otra paciente con un hematoma de mama en el contexto de un tratamiento anticoagulante que requirió drenaje quirúrgico, momento en el que se reveló una aparente lesión maligna subyacente que se confirmó histológicamente

Some benign breast lesions, such as hematoma, may present mammographically asa speculated or ill-defined mass mimicking a carcinoma. Equally, an unknown malignant lesion can bleed and appear clinically as a breast hematoma. We report the cases of two patients: the first patient had a mammographic lesion suggestive of carcinoma that was later revealed to be a breast hematoma. The second patient, who was receiving anticoagulant therapy, had a breast hematoma that required surgical drainage. Surgery revealed an apparently malignant underlying lesion. The malignancy was confirmed by histological analysis

Amyloid imaging with (11)C-PIB PET/CT and glucose metabolism with (18)F-FDG PET/CT in a study on cognitive impairment in the clinical setting.

OBJECTIVE: The objective of this study was to evaluate the contribution of amyloid imaging with (11)C-Pittsburgh compound B ((11)C-PIB) and of glucose metabolism on F-fluorodeoxyglucose ((18)F-FDG) PET/CT to the study of cognitive impairment in the clinical setting. PATIENTS AND METHODS: Thirty-four patients (15 male, 19 female) were enrolled in the study. They were classified according to their clinically presented symptoms. Six patients had subjective memory complaints, five had nonamnestic mild cognitive impairment (MCI), seven had amnestic MCI, seven had prodromal Alzheimer's disease (AD), five had frontotemporal dementia, two had dementia with Lewy bodies, and two had cortical degeneration. All the scans were conducted to determine the likelihood of AD or to differentiate between AD and other dementia. Static 30-min (11)C-PIB and 15-min (18)F-FDG PET/CT scans were obtained. A visual analysis of images was performed. RESULTS: Three of the six patients with subjective memory complaints had positive (11)C-PIB scans and one of them also had (18)F-FDG hypometabolism. All five nonamnestic MCI patients had normal (11)C-PIB and (18)F-FDG. Four of the seven amnestic MCI patients showed (11)C-PIB cortical retention but only one had positive (18)F-FDG. Positive (11)C-PIB and (18)F-FDG were detected in five of the seven prodromal AD patients. All the five patients with FDT had positive (18)F-FDG scans, but only one of the five had (11)C-PIB cortical retention. Both dementia with Lewy bodies and cortical degeneration patients had positive (11)C-PIB and (18)F-FDG scans. CONCLUSION: The combined use of (11)C-PIB and (18)F-FDG PET provides relevant information for the clinical management of cognitive impairment. The detection of positive (11)C-PIB cortical retention in patients may be an indicator of the need for further clinical assessment and monitoring.

Trombosis venosa ovárica bilateral idiopática / Idiopathic bilateral ovarian vein thrombosis

La trombosis de la vena ovárica es una afección poco frecuente asociada a estados de hipercoagulabilidad, generalmente en el período puerperal. Presentamos un caso de trombosis bilateral idiopática de la vena ovárica en una mujer con dolor abdominal bajo (AU)

Ovarian vein thrombosis is an uncommon condition associated with hypercoagulatedstatus, generally in the puerperal period. We report a case of idiopathic bilateral ovarian veinthrombosis in a woman with lower abdominal pain (AU)

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit.

BACKGROUND: Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted "bundle" approach in controlling CVC-ABSIs outside ICU. METHODS: From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. RESULTS: Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91). CONCLUSION: The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

Extrapulmonary tuberculosis: epidemiology and risk factors

Objetivo: Conocer la epidemiología y los factores de riesgo asociados con la tuberculosis extrapulmonar(EPTB).Método: Los casos de tuberculosis (TB) diagnosticadas entre 1991-2008 en una población caucásica fueron clasificados como EPTB o TB pulmonar (PTB). De todos los casos, 63,7% fueron seguidos en una consulta monográfica de TB. Se utilizó un protocolo estandarizado para la recogida de los datos, incluyendo: sexo, edad, vacunación con BCG, contacto con algún paciente con PTB, tabaquismo, alcoholismo, diabetes mellitus, corticoides/fármacos inmunosupresores e infección por el VIH. Se compararon las variables entre los grupos de EPTB y de PTB. El análisis estadístico se basó en un estudio de regresión logística. Se calcularon los odds ratio (OR) y sus intervalos de confianza (IC) del 95%.Resultados: Entre 2.161 casos diagnosticados, 1.186 fueron PTB y 705 EPTB. La incidencia global de TB disminuyó desde 79.9/100.000 en 1992 hasta 27.1/100.000 en 2008, p<0,05. El número de casos de EPTB disminuyó de forma más lenta que el de PTB. La proporción de EPTB aumentó desde 30,6% de los casos en 1991-1996 hasta 37,6% en 2003-2008 (la localización ganglionar aumentó un 27%), p<0,05 en un ji al cuadrado de tendencia. En el estudio multivariante, ser mujer (OR 2,04; IC 95%: 1,56-2,66) y la edad (OR1,02; IC 95%: 1,01-1,022) se asociaron con EPTB mientras que el alcoholismo (OR 0,33; IC 95%: 0,20-0,52),

Objective To describe the epidemiology and risk factors associated with extra-pulmonary tuberculosis (EPTB).Method Cases of tuberculosis (TB) diagnosed from 1991 to 2008 in a Caucasian population were classified as EPTB or pulmonary TB (PTB). Of all cases, 63.7% were followed up in a specialist TB unit. A standardised protocol for data collection was used, including: gender, age, BCG vaccination, contact with PTB patient, smoking habit, alcohol abuse, diabetes mellitus, immunosuppressive drugs/steroids and HIV-status. These variables were compared between EPTB and PTB groups. Statistical analysis was based on logistic regression. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. Results Among the 2,161 cases diagnosed, 1,186 were PTB and 705 EPTB. The overall TB incidence had fallen from 79.9/100,000 in 1992 to 27.1/100,000 in 2008, P<.05. The number of EPTB cases decreased more slowly than PTB. EPTB increased from 30.6% of cases in 1991-1996 to 37.6% in 2003-2008 (lymphatic site increased 27%), by trend test P<.05. At multivariate level, being female (OR 2.04; 95% CI: 1.56-2.66) and age (OR 1.02; 95% CI: 1.01-1.022) were associated with EPTB, while alcohol abuse (OR 0.33; 95% CI: 0.20-0.52), smoking habit (OR 0.45; 95%CI: 0.34-0.59), contact with PTB patients (OR 0.57; 95% CI: 0.44-0.76) and BCG vaccination (OR 0.64; 95% CI: 0.44-0.92) had a protective effect. The proportion of female gender and age of patients increased over time, whilst there was a decrease in BCG vaccinated patients. Conclusions Whilst there has been a reduction in the overall incidence of TB, the proportion of EPTB increased. The proportional increase in EPTB could be explained by an increase in life expectancy and the predominance of women in the population, and by a decline in BCG vaccinated patients(AU) el tabaquismo (OR 0,45; IC 95%: (..) (AU)

Extrapulmonary tuberculosis: epidemiology and risk factors.

OBJECTIVE: To describe the epidemiology and risk factors associated with extra-pulmonary tuberculosis (EPTB). METHOD: Cases of tuberculosis (TB) diagnosed from 1991 to 2008 in a Caucasian population were classified as EPTB or pulmonary TB (PTB). Of all cases, 63.7% were followed up in a specialist TB unit. A standardised protocol for data collection was used, including: gender, age, BCG vaccination, contact with PTB patient, smoking habit, alcohol abuse, diabetes mellitus, immunosuppressive drugs/steroids and HIV-status. These variables were compared between EPTB and PTB groups. Statistical analysis was based on logistic regression. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. RESULTS: Among the 2,161 cases diagnosed, 1,186 were PTB and 705 EPTB. The overall TB incidence had fallen from 79.9/100,000 in 1992 to 27.1/100,000 in 2008, P<.05. The number of EPTB cases decreased more slowly than PTB. EPTB increased from 30.6% of cases in 1991-1996 to 37.6% in 2003-2008 (lymphatic site increased 27%), by trend test P<.05. At multivariate level, being female (OR 2.04; 95% CI: 1.56-2.66) and age (OR 1.02; 95% CI: 1.01-1.022) were associated with EPTB, while alcohol abuse (OR 0.33; 95% CI: 0.20-0.52), smoking habit (OR 0.45; 95%CI: 0.34-0.59), contact with PTB patients (OR 0.57; 95% CI: 0.44-0.76) and BCG vaccination (OR 0.64; 95% CI: 0.44-0.92) had a protective effect. The proportion of female gender and age of patients increased over time, whilst there was a decrease in BCG vaccinated patients. CONCLUSIONS: Whilst there has been a reduction in the overall incidence of TB, the proportion of EPTB increased. The proportional increase in EPTB could be explained by an increase in life expectancy and the predominance of women in the population, and by a decline in BCG vaccinated patients.

Non-hospital-associated methicillin-resistant Staphylococcus aureus and MRSA chronic carrier patients in infection control.

This study reports research on methicillin-resistant Staphylococcus aureus (MRSA) colonized-infected patients who were admitted to a 320-bed hospital. Specifically, we report on the difficulties related to MRSA infection control as a consequence of the increasing incidence of non-hospital-associated MRSA acquisition and patients as chronic carriers who are frequently readmitted to the hospital.

[Use of diagnostic and therapeutic resources in patients hospitalized for heart failure: influence of admission ward type (INCARGAL Study)]. / Utilización de recursos diagnósticos y terapéuticos en pacientes ingresados por insuficiencia cardíaca: influencia del servicio de ingreso (estudio INCARGAL).

BACKGROUND: Heart failure (HF) is the most rapidly growing cardiac pathology in industrialized countries, and already the primary cause of hospital admissions of elderly people. Outside the field of clinical trials, there have not been many studies in Spain of the influence of the admission department on diagnostic and therapeutic management, whether this affects short-term and long-term prognosis, and the factors that determine the department the patient is admitted to. OBJECTIVE: . To analyze whether management and prognosis of patients admitted with heart failure differ depending on the admission ward (cardiology versus internal medicine-geriatrics). PATIENTS AND METHODS: Cross-sectional study of 951 patients (505 men and 446 women) consecutively hospitalized for HF in the cardiology (n = 363) and internal medicine-geriatrics (n = 588) wards of 12 hospitals of Galicia and recruited over a maximum period of 6 months. The main epidemiological and clinical variables were recorded at admission, and the complications, treatments, and clinical status were recorded at release.Results. HF patients had a mean age of 75.5 12 years (women 78.5 years and men 72.6 years). The average hospitalization time was 11 8 days and 50.8% were first admissions. Total hospital mortality was 6.8%. Fifty-nine percent (58.9%) of patients had arterial hypertension, 31.9% ischemic heart disease, 27.6% cardiac valve disease, 28.5% diabetes mellitus, and 32.5% chronic obstructive pulmonary disease (COPD). The patients admitted to cardiology ward were younger (72.5 13 vs 77.4 11 years; p < 0.005), more frequently men (51.9 vs 43.7%; p < 0.005), more often first hospitalizations (54.8 vs 48.4%; p < 0.005), and acute pulmonary edema was more common (22.8 vs 9.2%; p < 0.005). The odds ratio (and 95% CI) for therapeutic and diagnostic procedures in relation to admission ward (reference group internal medicine-geriatrics), adjusted for age, sex, systolic function, number of hospitalizations, and history of dementia, hypertension, COPD, AMI, valve disease and ischemic heart disease, are: echocardiogram, 3.49 (2.58-4.73); catheterization, 6.42 (3.29-12.55), admission to intensive care, 3.94 (2.15-7.25), revascularization, 2.15 (0.57-8.08), and beta-blocker treatment, 3.39 (1.93-5.97). No differences in hospital mortality (6.6% in cardiology vs 7% in internal medicine-geriatrics) or average hospitalization time were found between departments. CONCLUSIONS: The admission ward was related with a clear difference in HF management, with better adherence to guidelines and more use of resources by cardiologists. This was unrelated with differences in hospital mortality so a longer follow-up of these patients is required to evaluate the impact of these therapeutic measures on the prognosis and evolution of HF, as well as the cost-benefit relation in an elderly patient population.

[The advantages of a programme for training carers of persons with dementia: a pilot study by specialised nurses]. / Beneficios de un programa de formación del cuidador en la demencia: experiencia piloto desde la enfermería especializada.

INTRODUCTION: The care of patients with dementia usually has to be undertaken by persons with no formal training. However, the chances of treatment being effective depends on them. Specialist non hospital nurses, who are accessible and close to these patients, are in a privileged position to develop programmes to train carers. In our country no studies have been done to evaluate the efficacy of such programmes. OBJECTIVES: To evaluate the efficacy of a programme for training carers of patients with irreversible dementia. The programme was designed and carried out by specialist nurses, based on a neurology clinic outside the hospital. PATIENTS AND METHODS: Ten carers who came consecutively to the clinic were invited to participate in the programme. Before and after the programme we evaluated cognitive, functional behaviour and affective aspects of the patient and/or carer. RESULTS: As far as the patient was concerned no changes were found in either cognitive or functional aspects. Although the behaviour problems were reduced, they caused less stress to the carer after the training sessions. At the same time the affectivity of the patients improved. CONCLUSIONS: It is possible to carry out effective training programmes for carers of demented patients, with relatively little expense. Affectivity, both of the patient and the carer is the aspect most improved by this training. Large scale trials are necessary to show improvement of other aspects, and to compare different types of training programmes.

Apoyo a los cuidadores de pacientes con enfermedad de Alzheimer: un programa desde la enfermería de atención especializada / Support for the carers of patients with Alzheimer’s disease

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Beneficios de un programa de formación del cuidador en la demencia: experiencia piloto desde la enfermería especializada / The advantages of a programme for training carers of persons with dementia: a pilot study by specialised nurses

Introducción. El cuidado de los pacientes con demencia recae en la mayoría de los casos en personas que no han recibido una preparación formal. Ellos son, sin embargo, la garantía para que cualquier intervención terapéutica resulte eficaz. La enfermería especializada extrahospitalaria, por su cercanía y accesibilidad, ocupa una posición privilegiada para desarrollar programas de formación dirigidos a cuidadores. En este ámbito, no existen en nuestro país experiencias cuya eficacia haya sido evaluada. Objetivo. Valorar la eficacia de un programa de formación del cuidador en pacientes con demencia irreversible. Programa diseñado y ejecutado por personal de enfermería especializado, y realizado desde una consulta de neurología extrahospitalaria. Pacientes y métodos. Se ofreció el programa a 10 cuidadores que acudieron de forma consecutiva a la consulta. Se valoraron, antes y después de la intervención, aspectos cognitivos, funcionales, conductuales y afectivos, en el paciente y/o en el cuidador. Resultados. Respecto al paciente no se apreciaron cambios en la esfera cognitiva ni en la funcional. Aunque los problemas de conducta no disminuyeron, éstos generaban menos estrés en el cuidador después de la intervención. Asimismo se observó una mejoría en la afectividad de los pacientes. Conclusiones. Es posible llevar a cabo programas eficaces de formación del cuidador en la demencia, con relativa economía de medios. La afectividad, tanto del paciente como del cuidador, es el área más sensible a este tipo de intervenciones. Es preciso realizar experiencias a mayor escala, con el fin de demostrar beneficios a otros niveles, y de comparar distintos tipos de intervenciones (AU)

Infección por el VIH en el paciente hemofílico / Prevalence of human immunodeficiency virus antibodies in hemophiliacs

Para determinar la prevalencia de anticuerpos contra el virus de la inmunodeficiencia humana (V.I.H.) en nuestros pacientes hemofílicos, se estudiaron mediante el método inmunoenzimático aquéllos cuya hemofília se considera de grado moderado o grave. De los 84 pacientes estudiados, 24 se encontraron positivos en dos determinaciones séricas, efectuándose además el examen ENVACORE resultando en todos ellos de nuevo positivo, para una prevalencia de 28.5%. Veinte de ellos se encuentran asintomáticos, tres presentan linfadenopatía crónica y uno síndrome febril, hepato-esplenomegalia y linfadenopatía. Consideramos que nuestra prevalencia es mucho menor que las informadas por otros autores. Ninguno de nuestros pacientes ha desarrollado el síndrome completo, lo que quizá dependa de exposiciones múltiples al V.I.H., intensidad y naturaleza de la respuesta de anticuerpos y de muchos otros factores aún no conocidos

Un caso de amiloidosis sistémica y deficiencia de factor X asociada con mieloma múltiple / A case of systemic amyloidosis and factor X deficiency associated with multiple myeloma

Se describe el caso de un paciente masculino de 50 años con síndrome de amiloidosis primaria y deficiencia adquirida de factor X asociada con mieloma múltiple. Las manifestaciones clínicas más importantes consistieron en infiltracion amiloide sistémica y hemorragia por mucosa gingival. El estudio integral del paciente se llevó a cabo a partir del hallazgo inicial de prolongación del tiempo de protrombina y del tiempo de tromboplastina activado. La reacción al tratamiento fue insatisfactoria, y el paciente falleció poco después de haberse logrado aparentemente la estabilización de sus complicaciones cardiovasculares y renales