Papel del bloqueo ecoguiado del plano del músculo serrato en el dolor neuropático crónico tras una cirugía de mama en una paciente de cáncer / The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient

Antecedentes: El cáncer de mama es el tipo de cáncer más frecuente entre las mujeres. Entre las secuelas de su tratamiento se encuentra el dolor neuropático crónico tras la cirugía de mama (CNPBS). El tratamiento del dolor es difícil y consiste normalmente en una terapia farmacológica aunque, sin embargo, los estudios recientes han defendido el uso de técnicas locorregionales como adyuvantes. El bloqueo del plano del músculo serrato (SPB) ha surgido recientemente como herramienta potencial para controlar el CNPBS. El objetivo de este estudio es evaluar la eficacia y papel potencial del SPB ecoguidado en el CNPBS. Métodos: Se realizó un análisis retrospectivo en 30 pacientes con CNPBS refractario a terapia farmacológica, sometidas a SPB entre 2017 y 2019. Se analizaron los parámetros siguientes: dolor basal, dolor a las 24 horas, una semana y un mes. Se aplicó la prueba de Mann-Whitney. Se consideró significación estadística al nivel de p < 0,05. Todos los análisis estadísticos se realizaron utilizando SPSS 20. Resultados: Tres pacientes fueron excluidas. Transcurridas 24 horas, reportamos mejora del dolor (al menos una reducción del 30% sobre la puntuación del dolor basal) en 20 pacientes, y en 12 transcurrida una semana. Al cabo de un mes, 22 pacientes habían experimentado mejora, de los cuales: 11 mejoraron sin ajuste terapéutico, 11 pacientes mejoraron con ajuste terapéutico (ocho con monoterapia de gabapentinoides, tres con introducción de politerapia), y cinco pacientes no experimentaron mejora. Conclusión: Nuestro estudio demostró que SPB es una alternativa válida para el tratamiento de CNPBS cuando la terapia farmacológica se ha mostrado insuficiente, no habiéndose reportado efectos secundarios. Son necesarios estudios aleatorios para evaluar la magnitud de SPB en CNPBS, e identificar a los pacientes que más se beneficiarían de SPB.(AU)

Background: Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. Methods: A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 hours, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. Results: 3 patients were excluded. At 24 hours, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn’t improve. Conclusión: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.(AU)

Alfabetización en salud en pacientes con diabetes tipo 2: un estudio transversal con el cuestionario HLS-EU-Q47 / Health literacy in patients with type 2 diabetes: A cross-sectional study using the HLS-EU-Q47 questionnaire

OBJETIVO: Determinar el grado de alfabetización en salud de pacientes diabéticos de Ourense, de 50 a 75 años de edad, y su relación con la concentración de hemoglobina glicada y el riesgo cardiovascular. MATERIALES Y MÉTODOS: Estudio transversal mediante cuestionario autocumplimentado. A partir de muestreo polietápico fueron incluidos aleatorizadamente pacientes diabéticos de tipo 2 pertenecientes a cupos urbanos de la ciudad de Ourense. Se analizó a un total de 103 pacientes. Se determinaron: grado de alfabetización en salud utilizando el cuestionario HLS-EU-Q47, último valor de hemoglobina glicada y el riesgo cardiovascular se calculó con el algoritmo UKPDS. Edad, sexo, nivel educativo, grado de apoyo social, clase social y comorbilidad se utilizaron como covariables. RESULTADOS: El 81,5% (84) tenía un nivel de alfabetización en salud inconveniente (el 29,1% nivel inadecuado y el 52,4% nivel problemático). Se observó asociación entre mayores grados de alfabetización en salud y niveles más altos de educación (p < 0,001). El nivel de hemoglobina glicada estaba relacionado de forma negativa con el grado de alfabetización en salud, de tal forma que un mayor grado de alfabetización implicaba un menor valor de hemoglobina glicada (p = 0,03). No se encontró asociación con el riesgo cardiovascular (p = 0,3). CONCLUSIONES: El grado de alfabetización en salud de la población analizada fue insuficiente y su incremento podría suponer mejores resultados clínicos en el tratamiento de los pacientes diabéticos

OBJECTIVE: The aim of this study was to determine the level of health literacy of diabetic patients aged 50 to 75 years, from Ourense, Spain, as well as its relationship with the glycated haemoglobin (HbA1c) concentration and cardiovascular risk of the patient. MATERIAL AND METHODS: Cross-sectional study using a self-completed questionnaire. From a multi-stage sampling, urban, type 2 diabetic patients were randomly included. The level of health literacy, using the HLS-EU-Q47 questionnaire, the last concentration of HbA1c, and both total and fatal cardiovascular risk at 10 year follow-up, measured using the UKPDS (U.K. Prospective Diabetes Study) algorithm, were determined. The age, gender, level of education, level of social support, social class, and comorbidities were used as covariates. RESULTS: A total of 103 patients were analysed. Out of all the patients, 81.5% (84) had an unsuitable health literacy level (29.1% had an inadequate level and 52.4% had a problematic level). A clear association was seen between a higher level of health literacy and higher levels of education. Moreover, the level of health literacy was seen to be inversely related to the level of control of the patients' diabetes measured on the basis of their HbA1c (P = .03) concentration. However, no such association was found with the cardiovascular risk (P = .3). CONCLUSIONS: The results of the present study show that the level of literacy of the analysed population was insufficient, and that its improvement could result in a better outcome in the treatment of diabetic patients

Oral yeast colonization throughout pregnancy.

BACKGROUND: Recent studies suggest that placenta may harbour a unique microbiome that may have origin in maternal oral microbiome. Although the major physiological and hormonal adjustments observed in pregnant women lead to biochemical and microbiological modifications of the oral environment, very few studies evaluated the changes suffered by the oral microbiota throughout pregnancy. So, the aim of our study was to evaluate oral yeast colonization throughout pregnancy and to compare it with non-pregnant women. MATERIAL AND METHODS: The oral yeast colonization was assessed in saliva of 30 pregnant and non-pregnant women longitudinally over a 6-months period. Demographic information was collected, a non-invasive intra-oral examination was performed and saliva flow and pH were determined. RESULTS: Pregnant and non-pregnant groups were similar regarding age and level of education. Saliva flow rate did not differ, but saliva pH was lower in pregnant than in non-pregnant women. Oral yeast prevalence was higher in pregnant than in non-pregnant women, either in the first or in the third trimester, but did not attain statistical significance. In individuals colonized with yeast, the total yeast quantification (Log10CFU/mL) increase from the 1st to the 3rd trimester in pregnant women, but not in non-pregnant women. CONCLUSIONS: Pregnancy may favour oral yeast growth that may be associated with an acidic oral environment.

Adecuación diagnóstica en la Enfermedad Pulmonar Obstructiva Crónica / The adequacy of the diagnostic in chronic obstructive pulmonary disease

Objetivos. Valorar la adecuación a las guías clínicas (GOLD/SEPAR) del diagnóstico de los pacientes calificados de Enfermedad Pulmonar Obstructiva Crónica (EPOC). Material y métodos. Se seleccionaron todos los casos de EPOC del registro de pacientes crónicos de 28 cupos de 9 centros de salud de la provincia de Ourense, incluyéndose 382 casos donde se determinó la existencia de un diagnóstico correcto según resultados espirométricos. Se determinaron los factores asociados al diagnóstico correcto mediante regresión logística donde fueron incluidos edad, sexo, residencia (rural/urbana), tabaquismo, gravedad, nivel de seguimiento y tiempo desde el diagnóstico. Resultados. Eran varones 297 (77,7%) y 172 (45,0%) procedían del medio rural. La media (DE) de edad era 77,0 (±11,0) años, siendo al diagnóstico de 64,9 (±12,0) años y 11,5 (±8,0) años de tiempo de evolución. El 64,9% era o había sido fumador. Se diagnosticaron en atención primaria 26 casos (6,8%). El índice VEF1/CVF estaba registrado en 174 (45,5%) pacientes, siendo menor de 0,7 en 138 casos (36,1%), que se consideraron bien diagnosticados. En estos pacientes figuraba registrado el VEF1 en 125 casos (90,6%). El diagnóstico correcto se asociaba a enfermedad grave o muy grave (OR 5,2; IC95 1,5-17,4), procedencia urbana (OR 6,1; IC95 1,7-21,2) y edad igual o menor de 60 años (OR 3,7; IC95 1,3-11,2). Conclusión. En la historia clínica de atención primaria de los pacientes diagnosticados de EPOC existía escaso registro espirométrico y baja adecuación a los criterios diagnósticos aceptados en las guías de uso habitual (AU)

Objectives. To assess the adequacy to the clinical guides (GOLD/SEPAR) for the diagnosis of the patients classified as COPD. Material and methods. We selected all COPD cases in the registry of chronic patients of 28 general practitioners from 9 Health Centres in the province of Ourense (Spain). A total of 382 cases were included. Diagnostic accuracy was determined according to the results of spirometry. We identify factors associated with correct diagnosis by logistic regression which included age, gender, residence (rural/urban), smoking, severity, level of follow up and time since diagnosis. Results. Of the total number included, 297 were male (77.7%) and 172 patients (45.0%) came from rural areas. The average age was 77.0 (SD=±11.0) years, with a mean age at diagnosis of 64.9 (±12.0) years and the time from diagnosis was 11.5 (±8.0) years. Less than half (49.1%) patients had been smokers, and 13.1% still smoked. Twenty-six cases (6.8%) were diagnosed in Primary Care. The FEV1/FVC ratio was recorded in 174 (45.5%) patients, with less than 0.7 in 138 cases (36.1%), which were considered as correctly diagnosed. In these patients the FEV1 had been recorded in 125 cases (90.6%). A correct diagnosis was associated with severe or very severe disease (OR 5.2; 95% CI; 1.5-17.4), urban areas (OR 6.1; 95% CI, 1.7-21.2), and younger than 60 years (OR 3.7; 95% CI, 1.3-11.2). Conclusion. The number of spirometry results recorded in the Primary Care medical records of patients diagnosed with COPD was found to be low, and with little adaptation to the accepted diagnostic criteria in the guidelines that are used routinely (AU)

Síndrome RS3PE: Remitting Seronegative Symmetrical Synovitis with Pitting Edema. A propósito de 3 casos / RS3PE Syndrome: Remitting Seronegative Symmetrical Synovitis with Pitting Edema: a presentation of 3 cases

El síndrome RS3PE (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) es un cuadro reumatológico, relativamente infrecuente, que afecta de manera predominante a ancianos y cuya importancia radica en la necesidad de establecer el diagnóstico diferencial con otras enfermedades más graves, dada su buena respuesta habitual al tratamiento con corticoides orales (AU)

RS3PE (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) is a relatively rare rheumatological disease, which predominantly affects the elderly. Its importance lies in the need for a differential diagnosis with other more serious diseases, given its usual good response to treatment with oral corticosteroids (AU)

Effects of fishing technique on assessing species composition in aquatic systems in semi-arid Brazil / Efeitos de diferentes artes de pesca na avaliação da composição de espécies em ambientes aquáticos do semiárido brasileiro

In most ecological field research, appropriate sampling is critical for the understanding of processes underlying fish populations and communities, and is even more important in heterogeneous environments such as the aquatic systems of the semi-arid region of Brazil. This study intends to make a contribution to the development of sampling programs and gear selection in aquatic systems of semi-arid Brazil by evaluating the effects of different fishing techniques on the assessment of richness and composition of the fish fauna in selected aquatic environments. Six sites were selected to represent typical artificial (reservoirs) and natural (intermittent streams) environments and four different types of sampling gear were applied to each site during four occasions. The present study shows that when selecting sampling techniques to be used in aquatic systems in semi-arid Brazil, one must consider the objectives of the study, e.g. ecological or taxonomic, in order to decide on inclusion of rare species in the sampling population. Also, the effect of the sampling gear on natural abundances of fish must be considered given that some sampling techniques are highly detrimental to fish population numbers.

Na maioria dos estudos ecológicos, uma amostragem representativa é crucial para o conhecimento dos processos que organizam populações e comunidades de peixes, principalmente em ambientes reconhecidamente heterogêneos como os ecossistemas aquáticos da região semiárida do Brasil. O presente estudo pretende contribuir para este conhecimento avaliando os efeitos de diferentes técnicas de captura de peixes na riqueza e composição das espécies amostradas em ambientes aquáticos do semiárido. Seis pontos de coleta foram selecionados, representando ambientes aquáticos artificiais (açudes) e naturais (rios intermitentes), onde quatro tipos de apetrechos de pesca foram empregados em quatro ocasiões. O presente estudo mostra que, ao selecionar técnicas de amostragem de peixes em ambientes aquáticos do semiárido brasileiro, dois fatores devem ser levados em consideração: primeiro, os objetivos do estudo, ecológicos ou taxonômicos, para se avaliar a importância da inclusão de espécies raras na população amostral; e segundo, os efeitos da técnica de amostragem na abundância natural de espécies, tendo em vista que algumas artes de pesca têm um efeito negativo nos números populacionais das espécies de peixes.

Resultados de la aplicación de la prueba monoaural con palabra comprimida en español al 75% y al 100% en casos de tartamudez y controles / Results from applying the monaural compressed speech test in spanish at 75% and 100% in cases of stuttering and controls

Objetivo. Evaluar los resultados de la aplicación de la prueba de palabra comprimida en español (PPCE) al 75%y al 100% en sujetos con tartamudez y controles. Sujetos y métodos. Se incluyeron en el estudio 50 casos con edades comprendidas entre los 8 y los 36 años, 25 de ellos con tartamudez y 25 como controles pareados uno a uno por edad, sexo y escolaridad. No se incluyeron casos de tartamudez grave. Los sujetos debían tener funciones normales de audición, evaluada mediante audiometría y logoaudiometría periférica, y cognitivas, valoradas con TONI-2 en los niños y con el miniexamen del estadomental en los adultos. Resultados. El promedio de aciertos en la PPCE al 75% fue del 60,98% en los casos de tartamudez y del 82,04% en los controles (t de Student = −7,4; p = 0,0001), y en la PPCE al 100% fue del 56,56% y el 73,16%, respectivamente (t de Student = −5,9; p = 0,0001). Para cada prueba se calculó su sensibilidad y especificidad por medio de curvas COR, así como el punto de corte. Conclusión. La aplicación de las PPCE en individuos con tartamudez contribuyó a la identificación de las alteraciones en el procesamiento temporal de la información auditiva

Aim. To evaluate the results obtained from applying the monaural compressed speech test in Spanish at 75% and100% in cases of stutterers and controls. Subjects and methods. The study involved 50 cases with ages ranging from 8 to 36 years, 25 of whom were stutterers and 25 controls, who were paired one to one by age, sex and schooling. Severe cases of stuttering were not included. Subjects had to have normal auditory functioning, which was evaluated by means of audiometryand peripheral vocal audiometry, and also normal cognitive functioning, which was assessed using TONI-2 in children and by the Spanish version of the Mini-Mental State Examination in adults. Results. The average number of correct answers on theCSTS at 75% was 60.98% in cases of stutterers and 82.04% in the group of controls (Student’s t = –7.4; p = 0.0001), and on the CSTS at 100% the figures were 56.56% and 73.16%, respectively, (Student’s t = –5.9; p = 0.0001). Sensitivity and specificity were calculated for each test by means of ROC curves, together with the cut-off point. Conclusion. Applying the CSTS in individuals who stutter helped us to identify disorders in the temporal processing of auditory information

Atopic disease and body mass index / Enfermedad atópica e índice de masa corporal

Background: Obesity and atopy are two increasingly important population health issues. Excess weight and obesity are potential risk factors for atopy (specifically asthma). Objective and methods: To determine the body mass index (BMI) in children with atopic disease compared with nonatopic children, and to determine whether obesity is associated to more severe disease. Children aged 5 to 16 years with diagnosed atopic disease that attended the Ambulatory Hospital Center where eligible as cases. Children aged 5 to 16 years without atopic disease from a school in the same geographic area were used as controls. Results: A total of 228 children where included in the analysis: 112 children with atopy (75.9 % asthma, 21.4 % rhinitis and 2.7 % eczema) and 116 children without atopy. The median age was 10.5 and 10.3 years for the atopic and non-atopic children, respectively. The prevalence of overweight or obese subjects was significantly greater in the atopic group (44.6 % vs 31.9 %, p < 0.05). The obese asthmatic children had a significantly higher prevalence of sleep disturbances due to wheezing in the last 12 months (45.5 % vs 15.9 %, p < 0.05). They also reported dry cough at night more often (50 % vs 28.6 %, p = 0.07), and a higher number of wheezing attacks in the past 12 months (72.7 % vs 50.8 %, p = 0.074), than the non-obese asthmatic children. Most of the obese atopic children were already overweight or obese at the time of the diagnosis (66.6 %). None of the associations were significantly different for boys or girls. Discussion: There is some evidence of an association between excess body weight or obesity and atopy - particularly asthma

Antecedentes: obesidad y atopia son dos importantes problemas de salud en aumento. El sobrepeso y la obesidad son potenciales factores de riesgo para la atopia, especialmente el asma. Objetivo y Métodos: determinar el índice de masa corporal (IMC) en niños con enfermedad atópica, comparándolo con niños no atópicos, y ver si la obesidad se asocia con una mayor gravedad de la enfermedad. Se seleccionaron niños de edad comprendida entre 5 y 16 años diagnosticados de enfermedad atópica, atendidos en el Ambulatorio del Centro Hospitalario. Como controles se seleccionaron niños entre 5 y 16 años, de una escuela de la misma área geográfica que los atópicos. Resultados: un total de 228 niños se incluyeron en el análisis: 112 niños atópicos (75,9% asma, 21,4% rinitis y 2,7% eccema), y 116 niños no atópicos. La edad media fue 10,5 y 10,3 años, respectivamente de ambos grupos. La prevalencia de sobrepeso o de obesidad fue significativamente mayor en el grupo de atópicos (44,6% vs 31,9%, p<0.05). La prevalencia de trastornos del sueño, por disnea, en los últimos 12 meses, había sido significativamente mayor en los asmáticos obesos (45.5% vs 15.9%, p<0.005). También tuvieron tos seca por la noche con mayor frecuiencia(50% vs 28.6%, p=0.07), y mayor número de crisis de asma en los últimos 12 meses (72.7% vs 50.8%, p=0.074), que los asmáticos no obesos. Muchos de los niños atópicos obesos eran ya obesos o tenían sobrepeso cuando fueron diagnosticados de su enfermedad (66,6%). En ninguno de estos hallazgos hubo diferencia entre varones o niñas. Discusión: hay alguna evidencia de asociación entre el exceso de peso corporal o la obesidad, con la atopia, especialmente asma