Cáncer y riesgo cardiovascular / Cancer and cardiovascular risk

Los pacientes que sobreviven a un cáncer tienen una menor supervivencia a largo plazo, en parte debido al incremento de las enfermedades cardiovasculares (ECV). Hasta el 30% de los fallecimientos de pacientes con cáncer pueden ser de causa cardiovascular. El cáncer puede causar ateroesclerosis por diferentes mecanismos, los más frecuentes son las secuelas de los fármacos antitumorales, la radioterapia y el trasplante de células hematopoyéticas. Los factores de riesgo cardiovascular son prevalentes en los supervivientes de cáncer. Estos pacientes deberían ser considerados en alto riesgo cardiovascular. Se aconseja recomendar hábitos de vida saludables y un control estricto de los factores de riesgo. Hay una necesidad inmediata para ampliar la disponibilidad de servicios preventivos cardiovasculares de cara a reducir los efectos adversos tardíos de la quimioterapia y la radiación. La intervención precoz podría ayudar a mejorar el perfil de riesgo cardiovascular. (AU)

Cancer survivors have lower long-term survival, in part due to increased cardiovascular disease (CVD). Up to 30% of the deaths of patients with cancer may be due to cardiovascular causes. Cancer can cause atherosclerosis by different mechanisms, the most frequent being the sequelae of antitumour drugs, radiotherapy, and haematopoietic cell transplantation. Cardiovascular risk factors are prevalent in cancer survivors. These patients should be considered at high cardiovascular risk. It is advisable to recommend healthy lifestyle habits and strict control of risk factors. There is an immediate need to expand the availability of cardiovascular preventive services to reduce the late adverse effects of chemotherapy and radiation. Early intervention could help improve cardiovascular risk profile (AU)

Cáncer, tratamiento onco-hematológico y toxicidad cardiovascular / Cancer, onco-haematological treatment and cardiovascular toxicity

La mayor disponibilidad de nuevos tratamientos oncológicos en los últimos años ha conllevado una mejoría del pronóstico e incremento de la expectativa de vida de los pacientes con cáncer, si bien a expensas de un incremento del riesgo cardiovascular. Por este motivo ha surgido la necesidad de la creación de equipos multidisciplinares para la valoración conjunta de estos pacientes y así lograr optimizar la salud cardiovascular y la supervivencia global de estos pacientes, minimizando las interrupciones de los tratamientos onco-hematológicos. Existe un amplio abanico de toxicidades cardiovasculares asociadas a los diferentes tratamientos del cáncer. El control estructurado del riesgo cardiovascular antes, durante y después del tratamiento oncológico permite seguir estrategias de prevención, detección temprana y tratamiento precoz de las cardiotoxicidades. (AU)

The increased availability of new cancer treatments in recent years has led to improved prognosis and increased life expectancy for cancer patients, but at the expense of increased cardiovascular risk. For this reason, multidisciplinary teams need to be formed for the joint evaluation of these patients to optimise the cardiovascular health and overall survival of these patients and minimise interruptions to onco-haematological treatments. A wide range of cardiovascular toxicities are associated with the various cancer treatments. The structured control of cardiovascular risk before, during and after oncological treatment will enable strategies for the prevention, early detection and early treatment of cardiotoxicities. (AU)

[Cancer and cardiovascular risk]. / Cáncer y riesgo cardiovascular.

Cancer survivors have lower long-term survival, in part due to increased cardiovascular disease (CVD). Up to 30% of the deaths of patients with cancer may be due to cardiovascular causes. Cancer can cause atherosclerosis by different mechanisms, the most frequent being the sequelae of antitumour drugs, radiotherapy, and haematopoietic cell transplantation. Cardiovascular risk factors are prevalent in cancer survivors. These patients should be considered at high cardiovascular risk. It is advisable to recommend healthy lifestyle habits and strict control of risk factors. There is an immediate need to expand the availability of cardiovascular preventive services to reduce the late adverse effects of chemotherapy and radiation. Early intervention could help improve cardiovascular risk profile.

[Cancer, onco-haematological treatment and cardiovascular toxicity]. / Cáncer, tratamiento onco-hematológico y toxicidad cardiovascular.

The increased availability of new cancer treatments in recent years has led to improved prognosis and increased life expectancy for cancer patients, but at the expense of increased cardiovascular risk. For this reason, multidisciplinary teams need to be formed for the joint evaluation of these patients to optimise the cardiovascular health and overall survival of these patients and minimise interruptions to onco-haematological treatments. A wide range of cardiovascular toxicities are associated with the various cancer treatments. The structured control of cardiovascular risk before, during and after oncological treatment will enable strategies for the prevention, early detection and early treatment of cardiotoxicities.

Statistical power analysis of neutrality tests under demographic expansions, contractions and bottlenecks with recombination.

Several tests have been proposed to detect departures of nucleotide variability patterns from neutral expectations. However, very different kinds of evolutionary processes, such as selective events or demographic changes, can produce similar deviations from these tests, thus making interpretation difficult when a significant departure of neutrality is detected. Here we study the effects of demography and recombination upon neutrality tests by analyzing their power under sudden population expansions, sudden contractions, and bottlenecks. We evaluate tests based on the frequency spectrum of mutations and the distribution of haplotypes and explore the consequences of using incorrect estimates of the rates of recombination when testing for neutrality. We show that tests that rely on haplotype frequencies-especially Fs and ZnS, which are based, respectively, on the number of different haplotypes and on the r2 values between all pairs of polymorphic sites-are the most powerful for detecting expansions on nonrecombining genomic regions. Nevertheless, they are strongly affected by misestimations of recombination, so they should not be used when recombination levels are unknown. Instead, class I tests, particularly Tajima's D or R2, are recommended.

Estudio baropodométrico en el hemipléjico vascular: relación con la discapacidad, equilibrio y capacidad de marcha / Baropodomeptry Study In Vascular Hemiplegic Subject: Relationship with disability, balance and gait capacity

Objetivo. Análisis baropodométrico en hemipléjicos crónicos por accidente vascular cerebral (AVC) para evaluar su relación con medidas de equilibrio, marcha y discapacidad. Pacientes y método. Estudio descriptivo transversal en 37 hemipléjicos crónicos por AVC. En el estudio baropodométrico estático y dinámico (BAROPODÓMETRO ELECTRÓNICO MIDI-CAPTEURS S.A. BJL GROUP V. 2.08 [TWIN 99-Versión 1.02]) se analiza: área de contacto del apoyo plantar, simetría de distribución del peso corporal, presiones plantares y línea de progresión del paso. La discapacidad, equilibrio y capacidad de marcha se analizan mediante: functional independence measure (FIM), escala de Berg, velocidad de marcha, y escalas de marcha modified functional walking categories (MFWC) y scandinavian stroke scale. Resultados. La superficie apoyo relativa (SAR) del pie parético fue del 74 % respecto al sano, y se correlacionó significativamente con FIM (r 0,573), velocidad de marcha y equilibrio. La asimetría de distribución del peso corporal se correlacionó con FIM, velocidad de marcha, escala de Berg y escala MFWC. En dinámica, la superficie de apoyo plantar del paso parético fue significativamente menor (155 cm 2 frente a 139,8 cm 2, p = 0,01). El 48,6 % de los pacientes presentaron una alteración de la línea de progresión del paso del pie pléjico. La SAR dinámica en ambos pies se relacionó con FIM, Berg y velocidad de marcha. Conclusión. La asimetría en la superficie de apoyo plantar y en la distribución del peso corporal en estática, y la asimetría en la superficie de apoyo plantar en dinámica se relacionan significativamente con la discapacidad, equilibrio y capacidad de marcha en el hemipléjico vascular

Purpose. Assess static and dynamic baropodometry in chronic stroke patients. Evaluate its relationship to balance, gait and disability measurements. Patients and method. A descriptive cross-sectional study of 37 patients with chronic hemiparesis after stroke. Static and dynamic baropodometry (performed with MIDI-CAPTEURS S.A. BJL GROUP V. 2.08 ELECTRONIC PEL-38 BAROPODOMETRY SYSTEM [TWIN 99-1.02 version software]) was used to analyze plantar surface contact area, weight bearing symmetry, maximum and mean plantar pressures and gaitline. Disability, balance and gait were measured with the Functional Independence Measure (FIM), Berg Balance Scale (BBS), walking speed, Modified Functional Walking Categories (MFWC) and Scandinavian Stroke Scale (SSS). Results. Relative plantar surface in the paretic foot regarding the non-paretic side was 74 % and was significantly correlated with the Functional Independence Measure (FIM) (r 0.573), walking speed and BBS. Body weight bearing asymmetry correlated with FIM, walking speed, BBS and the MFWC. Plantar surface of paretic step was statistically smaller (155 cm 2 vs. 139.8 cm 2, p 0.01) and 48.6 % of patients showed asymmetry and abnormalities on the progression line of the paretic side. Correlation with FIM, BBS and walking speed was significant for the plantar step surface of both feet during the step. Conclusion. Plantar surface asymmetry and body weight bearing asymmetry in static standing as well as the dynamic plantar surface asymmetry along the step are significantly related with disability, balance and gait ability in stroke patients

[Short form 36 health questionnaire in hemiplegic patients 2 years after stroke]. / Cuestionario de salud Short Form 36 en pacientes hemipléjicos a los 2 años postictus.

INTRODUCTION: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables. METHODS: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient. RESULTS: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health). CONCLUSIONS: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support.

Short form 36 health questionnaire in hemiplegic patients 2 years after stroke / Cuestionario de salud Short Form 36 en pacientes hemipléjicos a los 2 años postictus

Introduction: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables. Methods: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient. Results: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health). Conclusions: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support (AU)

Introducción. Diferentes estudios señalan la afectación de la salud percibida de individuos con secuelas por enfermedad cerebrovascular en sociedades anglosajonas. Dada la escasez de trabajos en la población española, se diseña un estudio cuyo principal objetivo es comparar la salud percibida de pacientes con hemiplejía a los 2 años postictus respecto a la población general y relacionarla con variables demográficas, clínicas y funcionales. Métodos. Estudio transversal de 212 pacientes no institucionalizados. Principales variables recogidas: la percepción de salud medida con el cuestionario Short Form 36 (SF-36), la medida de la independencia funcional (FIM) motora y la Escala de depresión geriátrica (GDS). La pruebas estadísticas utilizadas fueron: Ç2, t de Student y el coeficiente de correlación de Spearman. Resultados. La percepción de salud de los hombres con hemiplejía postictus se encuentra disminuida en prácticamente todas las subescalas del SF-36 respecto a la población general. En las mujeres hemipléjicas la función física es la única subescala que se encuentra disminuida de manera significativa en todos los grupos de edad. Las variables que determinan una mayor afectación de la percepción de salud son: la presencia de depresión, la dependencia de tercera persona y el manifestar la necesidad de ayuda social. Existe una correlación significativa del SF-36 con la FIM motora (r = 0,737 para la función física) y con la GDS (r = -0,821 para la salud mental). Conclusiones. La percepción de salud de los pacientes hemipléjicos a los 2 años postictus se encuentra disminuida respecto a la población general española. Los factores que determinan una mayor afectación son la depresión, la dependencia de tercera persona en las áreas de función motora y el manifestar la necesidad de ayuda social (AU)

Necesidad de la enseñanza de pregrado en geriatría: aportaciones de un nuevo modelo educativo / Need for undergraduate teaching in geriatrics: contribution of a new educational model

Introducción: analizar la adquisición de conocimientos en la especialidad de Geriatría en estudiantes de la Facultad de Medicina de la Universidad de Castilla-La Mancha (UCLM). Material y métodos: a 93 alumnos de quinto curso de la Facultad de Medicina de la UCLM se les realizó una encuesta antes y después de recibir la asignatura (6 semanas teoricoprácticas basadas en el aprendizaje por problemas). Resultados: después de recibir la asignatura de Geriatría, los alumnos mejoraron sus conocimientos sobre la especialidad, tanto en su utilidad como en la metodología y en la tipología de los principales beneficiarios. Al concluir, el 59,8% identificó al anciano con discapacidad reciente potencialmente recuperable como principal beneficiario de una unidad geriátrica de agudos. Los principales beneficiarios de una unidad de recuperación funcional fueron ancianos con ictus, fracturas de cadera y pérdida de funcionalidad. Las afecciones que más se benefician de la atención en consultas externas son el deterioro cognitivo, el síndrome confusional agudo, la pérdida funcional, las caídas y la pluripatología-polifarmacia. Tras la asignatura se produjo un cambio de opinión en los alumnos hacia que los geriatras son quienes deben abordar el síndrome confusional agudo, el trastorno depresivo, la incontinencia urinaria y las caídas. Tras la formación, hay una tendencia a que más ancianos en situación aguda, con buena función previa y con una enfermedad potencialmente recuperable, como el ictus, sean atendidos por un geriatra. Conclusiones: la enseñanza de pregrado de la Geriatría mejora el conocimiento de la especialidad, aclara cuál es el tipo de paciente que más se beneficia de su metodología de trabajo y prepara a los futuros médicos para prestar mayor calidad en la asistencia a pacientes ancianos

Introduction: to analyse knowledge of geriatrics among students of the Medical Faculty of Castilla-La Mancha University (UCLM) in Spain. Matherial and methods: we performed a survey of 93 fifth-year medical students at the UCLM Medical Faculty before and after they attended a 6-week problem-based training program in geriatrics. Results: after the learning period, the students had a better knowledge of geriatrics, including its utility, methods, and patient characteristics. At the end of the program, 59.8% were able to identify elderly individuals with potentially reversible, recent-onset disability as the principal users of acute geriatric units; those with stroke, hip fracture or functional decline as the main users of geriatric rehabilitation units and those with cognitive or functional decline, confusion, falls or multiple disorders/medications as the main users of outpatient clinics. Students changed their belief that confusion, depression, urinary incontinence and falls have to be managed by geriatricians. After the program students believed that geriatricians managed more elderly people with good functional status and acute, potentially treatable diseases such as stroke. Conclusions: education in geriatrics gives medical students a better understanding of the principal users of geriatric medicine and the methodology used, and prepares them to provide better care to the elderly

Resultados funcionales de las resecciones de la cabeza radial tras su fractura / Functional results of radial head excision after fracture

Objetivo. El propósito de este trabajo fue valorar los resultados de la resección de la cabeza radial en fracturas de dicha estructura anatómica. Material y método. Se han revisado 21 fracturas cerradas de la cabeza radial tratadas quirúrgicamente mediante resección de la misma. La edad media de la serie fue de 55 años, con un 81 por ciento de mujeres. El 90 por ciento fueron fracturas tipo III de Mason, y en en el 81 por ciento no existían lesiones asociadas. El seguimiento medio postquirúrgico fue de 65 meses (24-161).Se realizó valoración funcional del codo y la muñeca según los criterios de Morrey y de Cooney, y radiológicamente se calculó el índice radiocubital distal, el ángulo de transporte del codo y la existencia de cambios degenerativos y calcificaciones en muñeca y codo. Resultados. Todos los casos presentaron migración proximal del radio de 1,43 mm de media y la medición del ángulo de transporte mostró un incremento promedio de 8,8°. Conclusiones. A pesar de los cambios mecánicos producidos, hemos encontrado que la resección de la cabeza radial en adultos alteraba escasamente la función del miembro superior, con más del 85 por ciento de excelentes y buenos resultados (AU)

Prosopagnosia y simultagnosia aisladas debidas a infarto isquémico en territorio occipito-temporal derecho / Isolated prosopagnosia and simultagnosia due to ischemic infarction in right occipitotemporal territory

No disponible

[Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate]. / Polineuropatia sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata.

INTRODUCTION: Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. CASE REPORT: We report the case of a 73 year old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino pelvic region and bone gammography, and had not previously been diagnosed. CONCLUSIONS: We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months.

Polineuropatía sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata / Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate

Introducción. Dentro de la sintomatología paraneoplásica de los cánceres se incluye la afectación neurológica a distintos niveles del sistema nervioso, tanto central como periférico, sin que esté bien definida su incidencia, variando la misma según el tipo de tumor. Caso clínico. Presentamos el caso de un varón de 73 años que ingresa por sospecha de polineuropatía de un mes de evolución. El diagnóstico se confirmó por electromiografía. Al efectuarse el estudio específico se encontró como única probable etiología un adenocarcinoma de próstata, con una amplia extensión en las cadenas ganglionares centrales y metástasis óseas, objetivadas por una tomografía computarizada abdominopélvica y gammagrafía ósea, no diagnosticado previamente. Conclusiones. Realizamos una revisión bibliográfica sobre la relación existente entre los síndromes paraneoplásicos neurológicos y las neoplasias de origen no pulmonar, en la que se ha encontrado una baja frecuencia de asociación entre ambos procesos, con escasas reseñas en la literatura sobre la asociación entre el adenocarcinoma de próstata y los procesos paraneoplásicos neurológicos. Existe una gran diversidad de expresión neurológica de estos síndromes, así como una asociación a distintos anticuerpos que podrían explicar un mecanismo etiopatogénico de carácter inmunitario. No existe un tratamiento efectivo a pesar de que éste suele ser agresivo y variado. El curso es con frecuencia rápidamente progresivo y conduce a la muerte en pocos meses (AU)

Introduction. Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. Case report. We report the case of a 73-year-old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino-pelvic region and bone gammography, and had not previously been diagnosed. Conclusions. We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months (AU)