Postsurgical Prosthetic Rehabilitation after Mandibular Ameloblastoma Resection: A 7-Year Follow-Up Case Report.

Ameloblastomas are benign but locally invasive odontogenic tumors most frequently located in the mandible. The gold standard of treatment is the surgical resection of the tumor with safety margins. Postsurgical defects generate a significant morbidity that needs reconstruction and oral rehabilitation to restore the oral functions. This case report describes the prosthetic rehabilitation of a 42-year-old male after resection of a mandibular ameloblastoma. Excision of the lesion by segmental mandibulectomy and mandibular reconstruction by microvascularized fibula flap was performed. After placement of 6 dental implants, the patient was rehabilitated with a lower hybrid prosthesis fabricated using computer-aided design-computer-aided manufacturing. During a 7-year and 5-month follow-up, some clinical complications were observed.

Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes / One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients

Introducción: Las hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las características clínicas y etiológicas de los pacientes con HSAc y conocer su pronóstico.MétodosEstudio observacional, prospectivo y multicéntrico. Se recogieron variables clínicas y radiológicas, y se siguió la evolución al año, observando la mortalidad, dependencia, tasa de resangrado y aparición de demencia.ResultadosSe incluyeron 34 pacientes (edad media 68,3 años, rango 27-89). Los síntomas más frecuentes fueron el déficit neurológico focal, con frecuencia transitorio y de repetición, y la cefalea. El TAC fue patológico en 28 pacientes (85%). Se realizó RM cerebral en 30 pacientes (88%), con isquemia aguda en 10 (29%), sangrados antiguos en 7 (21%) y siderosis superficial en otros 2 (6%). Se encontró etiología en 26 pacientes (76,5%): angiopatía amiloide (n = 8), ictus isquémico (n = 5), vasculitis (n = 4), encefalopatía posterior reversible (n = 2), trombosis venosa (n = 2), síndrome de vasoconstricción cerebral reversible (n = 2), oclusión carotidea (n = 1), síndrome de Marfan (n = 1) y carcinomatosis meníngea (n = 1). Durante el seguimiento fallecieron 3 pacientes (en 2 de ellos relacionado con la causa de la HSAc). Tres pacientes desarrollaron una demencia, 3 presentaron un hematoma lobar y otro una nueva HSAc.ConclusionesEn nuestra serie las causas más frecuentes de HSAc fueron la angiopatía amiloide, el ictus isquémico y la vasculitis. La HSAc tiene peor pronóstico que otras HSA no aneurismáticas. Puede tener numerosas causas y su pronóstico depende de la etiología subyacente. En el anciano existe una frecuente asociación con hemorragia intracraneal y deterioro cognitivo. (AU)

Introduction: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis.MethodsWe performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia.ResultsThe study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH.ConclusionsThe most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment. (AU)

Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: an observational multicentric study in 443 patients with melanoma.

BACKGROUND: Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis. OBJECTIVES: To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma. METHODS: We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded. RESULTS: The mean (SD) age of the patients was 55·98 (15·3) years and 50·6% were male. The median Breslow thickness was 0·85 mm. In total, 48 (10·8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2·6, 95% confidence interval (CI) 1·4-4·9; P = 0·004)] and > 4 mm (OR 3·6, 95% CI 1·7-7·9; P = 0·001), TMR > 5 per mm2 (OR 4·5, 95% CI 1·4-13·7; P = 0·009), SLN involvement (OR 2·3, 95% CI 1-5·7; P = 0·038) and tumour stages III-IV (vs. I-II) (OR 3·4, 95% CI 1·6-7·4; P = 0·002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness. CONCLUSIONS: T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.

One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients. / Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes.

INTRODUCTION: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. METHODS: We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. RESULTS: The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. CONCLUSIONS: The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.

Roles of the multiplex real-time PCR assay and ß-D-glucan in a high-risk population for intra-abdominal candidiasis (IAC).

Multiplex quantitative real-time PCR (MRT-PCR) using blood can improve the diagnosis of intra-abdominal candidiasis (IAC). We prospectively studied 39 patients with suspected IAC in the absence of previous antifungal therapy. Blood cultures, MRT-PCR, and ß-D-glucan (BDG) in serum were performed in all patients. IAC was defined according to the 2013 European Consensus criteria. For MRT-PCR, the probes targeted the ITS1 or ITS2 regions of ribosomal DNA. Candidaemia was confirmed only in four patients (10%), and IAC criteria were present in 17 patients (43.6%). The sensitivity of MRT-PCR was 25% but increased to 63.6% (P = .06) in plasma obtained prior to volume overload and transfusion; specificity was above 85% in all cases. BDG performance was improved using a cutoff > 260 pg/ml, and improvement was not observed in samples obtained before transfusion. In this cohort of high risk of IAC and low rate of bloodstream infection, the performance of non-culture-based methods (MRT-PCR or BDG) was moderate but may be a complementary tool given the limitations of diagnostic methods available in clinical practice. Volume overload requirements, in combination with other factors, decrease the accuracy of MRT-PCR in patients with IAC.

Mobilization of iron from ferritin: new steps and details.

Much evidence indicates that iron stored in ferritin is mobilized through protein degradation in lysosomes, but concerns about this process have lingered, and the mechanistic details of its aspects are lacking. In the studies presented here, 59Fe-labeled ferritin was induced by preloading hepatic (HepG2) cells with radiolabeled Fe. Placing these cells in a medium containing desferrioxamine resulted in the loss of ferritin-59Fe, but adding high concentrations of reducing agents or modulating the internal GSH concentration failed to alter the rates of ferritin-59Fe release. Confocal microscopy showed that Fe deprivation increased the movement of ferritin into lysosomes and hyperaccumulation was observed when lysosomal proteolysis was inhibited. It also resulted in the rapid movement of DMT1 to lysosomes, which was inhibited by bafilomycin. Ferrihydrite crystals isolated from purified rat liver/spleen ferritin were solubilized at pH 5 and 7 by GSH, ascorbate, citrate and lysosomal fluids obtained from livers and J774a.1 macrophages. The inhibition of DMT1/Nramp2 and siRNA knockdown of Nramp1 each reduced the transfer of 59Fe from lysosomes to the cytosol; and hepatocyte-specific knockout of DMT1 in mice prevented the release of Fe from the liver responding to EPO treatment, but did not inhibit lysosomal ferritin degradation. We conclude that ferritin-Fe mobilization does not occur through changes in cellular concentrations of reducing/chelating agents but by the coordinated movement of ferritin and DMT1 to lysosomes, where the ferrihydrite crystals exposed by ferritin degradation dissolve in the lysosomal fluid, and the reduced iron is transported back to the cytosol via DMT1 in hepatocytes, and by both DMT1 and Nramp1 in macrophages, prior to release into the blood or storage in ferritin.

Síndrome de Austrian / Austrian syndrome

No disponible

Estimation of the presence of unmetabolized dialkyl phthalates in untreated human urine by an on-line miniaturized reliable method.

At present, human exposure to dialkyl phthalates is assessed through urinary measurement of their metabolites due mainly to contamination in their analysis by their ubiquitous presence. An on-line miniaturized method and the processing of the untreated urine samples have been the key factors for minimizing contamination and achieving unbiased results. Di(2-ethylhexyl) (DEHP), diethyl (DEP), dibutyl (DBP) and mono-ethylhexyl (MEHP) phthalates in urine samples have been included in the study; MEHP as metabolite of the main dialkyl phthalate such as DEHP. On-line in-tube solid-phase microextraction (IT-SPME)-capillary liquid chromatography (CapLC) with diode array detection (DAD) is employed. The detection limits (LODs) achieved in urine were between 0.5 and 1.5 µg/L. Eighteen urines were processed. DBP and DEHP were found in nine and five samples, respectively and DEP in three of them. MEHP was only detected in one of the eighteen samples analyzed.

Amputación femoral por prótesis de rodilla infectada: serie de 4 casos clínicos / Femoral amputation after infected knee prosthesis: a series of 4 cases

Una de las posibles complicaciones después de la cirugía de la prótesis total de rodilla (PTR) es la infección. En ocasiones se debe tratar recurriendo a la amputación supracondílea de fémur. Hemos realizado una recopilación retrospectiva de 4 casos clínicos de pacientes después de la amputación supracondílea de fémur por infección de la PTR. Se han recogido las siguientes variables epidemiológicas: edad, sexo, índice de masa corporal (IMC), comorbilidades e índice de clasificación del estado físico según la American Society of Anesthesiology (ASA), extremidad afectada, cirugías y tiempo hasta la amputación, microorganismo aislado, complicaciones del muñón, presencia de síndrome del miembro fantasma, tiempo hasta la protetización y nivel funcional alcanzado. Hemos analizado los datos con el programa estadístico SPSS® v.19.0. Como conclusión, la protetización debe ser la principal opción a tener en cuenta para recuperar la funcionalidad de estos pacientes. En nuestro caso, la mitad de los pacientes han presentado un proceso de protetización satisfactorio (AU)

One of the possible complications after surgery for total knee replacement (TKR) is infection, which sometimes needs to be treated by an above knee amputation. We retrospectively reviewed 4 cases of patients with femoral amputation after infected knee prosthesis. We collected the following epidemiological variables: age, sex, body mass index (BMI), comorbidities and physical status classification according to the American Society of Anesthesiology (ASA), affected limb, surgery and time to amputation, microorganism isolated, stump complications, phantom limb syndrome, time to fitting the prosthetic limb, and functional level achieved. The data were analyzed with the SPSS® v.19.0 statistical program. To conclude, prosthetic fitting should be the primary consideration to recover functionality. The fitting process was satisfactory in half of our patients (AU)

Comparison between CHADS2 and CHA2 DS2 -VASc score in a stroke cohort with atrial fibrillation.

BACKGROUND AND PURPOSE: In patients with atrial fibrillation (AF), stroke risk stratification schemes have been developed to optimize antithrombotic treatment. The CHADS(2) score is frequently used but has limitations. The CHA(2) DS(2) -VASc score improves risk prediction. Our objectives are to describe CHADS(2) and CHA(2) DS(2) -VASc score distribution in a cohort of patients with AF and first-ever ischaemic stroke (FIS) and to identify differences in embolic risk stratification. METHODS: Our cohort included 589 patients with FIS, previous modified Rankin score ≤ 3, and non-valvular AF. We recorded demographic data, vascular risk factors, and antithrombotic pre-treatment. The CHADS(2) and CHA(2) DS(2) -VASc scores were calculated according to clinical status before stroke onset. RESULTS: In 186 (31.6%) patients, AF was previously unknown. Of patients with known AF and CHADS(2) ≥ 2 (n=320), only 103 (32.2%) were taking anticoagulants; more than half of these patients had an INR <2. The CHADS(2) score placed 142 (24.1%) patients in the low-intermediate risk (score ≤ 1) category compared with 21 (3.6%) with CHA(2) DS(2) -VASc, P < 0.001. Applying CHA(2) DS(2) -VASc reclassified 121 (85.2%) subjects in the CHADS(2) low-intermediate risk category as high risk (≥ 2), an indication for anticoagulants. Of the 21 patients who suffered a stroke despite their low CHA(2) DS(2) -VASc score (≤ 1), seven (33.3%) reported alcohol overuse, and six (28.5%) had a concomitant stroke etiology. CONCLUSIONS: About 25% of FIS patients with AF had a CHADS(2) score ≤ 1. Despite the high CHADS(2) score of our population, few patients received the recommended antithrombotic treatment according to their thromboembolic risk. Using the CHA(2) DS(2) -VASc schema significantly increased the percentage of patients indicated for anticoagulation.

Contención mecánica: su uso en cuidados intensivos / Mechanical Restraint: Its Use In Intensive Cares

Objetivo: Analizar la incidencia del uso de contención mecánica (CM) o restricción física en una unidad de cuidados intensivos y valorar el procedimiento. Procedimientos básicos Estudio descriptivo, prospectivo. Criterios de inclusión: pacientes que precisaron CM desde marzo a junio de 2010. Variables: demográficas, situación clínica, indicaciones, técnicas y dispositivos... Análisis estadístico con media, desviación estándar y porcentajes, con el programa SPSS 14.0.Resultados85 casos: 65,9% hombres, edad media de 64,19 (±17,9) y con NEMS de 29,3 (±8,2). Incidencia de CM: 15,6%. Indicación principal de CM: riesgo de interrupción grave de procesos terapéuticos (80%). Fue decisión enfermera (94,1%). Medida urgente: 85,9%. Registro del procedimiento: 57,6%. Información a la familia: 9,4%. Alternativa previa: contención verbal (100%), farmacológica (48,2%).Conclusiones Existe incidencia relevante de CM. Motivo principal: evitar la interrupción de procesos terapéuticos. La enfermera toma la decisión inicial. Es necesario la información/formación de los profesionales por sus repercusiones éticas y legales (AU)

Objective: To analyze the impact of the use of mechanical restraint (MR) or physical restraints in a Critical Care unit and to evaluate the procedure. Basic Procedures: A descriptive, prospective study. Inclusion criteria: patients who required MR from March to June 2010. Variables: demographic, clinical presentation, indications, techniques and devices. A statistical analysis with mean, standard deviation and percentages using the program SPSS 14.0.Results: A total of 85 cases were studied: 65.9% male, mean age 64.19 (±17.9), NEMS 29.3(±8.2). Incidence of MR: 15.6%. Main indication for MR: Risk of serious disruption of treatment processes (80%). Decision nurse (94.1%). Urgent action: (85.9%). Registration procedure: 57.6%.Information to the family: 9.4%. Previous actions: verbal containment (100%), pharmacological(48.2%).Conclusions: There is a relevant incidence of MR. The principal reason is that of avoiding interruption of the therapeutic process. The nurse makes the initial decision. Necessary information/training of professionals for legal and ethical repercussions is needed (AU)

[Mechanical restraint: its use in intensive cares]. / Contención mecánica: su uso en cuidados intensivos.

OBJECTIVE: To analyze the impact of the use of mechanical restraint (MR) or physical restraints in a Critical Care unit and to evaluate the procedure. BASIC PROCEDURES: A descriptive, prospective study. INCLUSION CRITERIA: patients who required MR from March to June 2010. VARIABLES: demographic, clinical presentation, indications, techniques and devices. A statistical analysis with mean, standard deviation and percentages using the program SPSS 14.0. RESULTS: A total of 85 cases were studied: 65.9% male, mean age 64.19 (±17.9), NEMS 29.3 (±8.2). Incidence of MR: 15.6%. Main indication for MR: Risk of serious disruption of treatment processes (80%). Decision nurse (94.1%). Urgent action: (85.9%). Registration procedure: 57.6%. Information to the family: 9.4%. Previous actions: verbal containment (100%), pharmacological (48.2%). CONCLUSIONS: There is a relevant incidence of MR. The principal reason is that of avoiding interruption of the therapeutic process. The nurse makes the initial decision. Necessary information/training of professionals for legal and ethical repercussions is needed.

Modelo hospitalario transversal: Mutua de Terrassa / A cross-disciplinary hospital model: The Mutua de Terrassa University Hospital

El objetivo del trabajo es describir nuestro modelo de gestión asistencial, analizar sus resultados y explicar propuestas innovadoras que desarrollamos en primaria ligadas a dicho modelo de gestión. Describimos nuestro servicio, su organización, recursos humanos y técnicos, gestión de calidad, coordinación con atención primaria, cartera de servicios y actividad de 2009. Analizamos el modelo de gestión, sus resultados y añadimos las propuestas innovadoras que estamos desarrollando. El Hospital Universitario Mutua de Terrassa está concertado con el sistema catalán de salud y su gestión es privada. La actividad asistencial se realiza de manera transversal en los diferentes niveles asistenciales. El modelo de gestión se basa en 3 puntos fundamentales: el continuum asistencial, el producto único y la gestión directa del jefe de servicio de los recursos humanos y técnicos, así como su participación activa en el proyecto. Ello ha requerido implementar una estructura física, recursos humanos y técnicos, estrechar la relación con primaria mediante la historia clínica informatizada y programas de tratamiento rehabilitador educacionales grupales multidisciplinarios. Un modelo transversal asegura el continuum asistencial y el producto único. Para ello, la gestión integral del proceso rehabilitador es fundamental. El hospital debe atender patologías complejas. Una sólida estructura en atención primaria es imprescindible y no menos importante es contar con medios a nivel sociosanitario y domiciliario. Debemos ser pioneros en la valoración del daño corporal y peritaje. La docencia estimula la calidad de la práctica clínica y la investigación (AU)

This article aims to describe our model of healthcare management, analyze its results and explain the innovative proposals we developed in primary care linked to this management model. We outline our service, its organization, human and technical resources, quality management, coordination with primary care, services’ portfolio and activity for 2009. The management model and its results, as well as the proposals we are currently developing in primary care are described. The Mutua de Terrassa University Hospital is linked to the Catalan health system but has private management. Healthcare activity is carried out across distinct levels of care. The management model is based on three main points: the continuum of care, the single product, and the direct management of human and technical resources by the departmental head, who also actively participates in the project. This model has required the implementation of a physical structure and human and technical resources and the establishment of closer links with primary care through computerized medical records and education programs in rehabilitation for multidisciplinary groups. A cross-disciplinary model ensures the continuum of care and the single product. Comprehensive management of the rehabilitation process is essential for this purpose. The hospital must address complex diseases. A strong primary care structure is essential. Equally important are geriatric and home-based services. The specialty of rehabilitation must move forward and education is crucial in stimulating the quality of clinical practice and research (AU)

Aspectos relacionados con caídas y equilibrio de los ancianos residentes en un centro sociosanitario / Aspects related to falls and balance of elderly residents in a care system

Introducción. El objetivo de este estudio ha sido evaluar, en los ancianos que están ingresados en un sistema sociosanitario y que realizan rehabilitación, algunas condiciones como equilibrio y movilidad funcional, así como conocer la prevalencia de las caídas y sus factores relacionados. Método. Realizamos un estudio de carácter transversal con individuos de 65 o más años de edad pertenecientes a nuestro hospital. Los que tenían condiciones de caminar con o sin la necesidad de ayudas técnicas realizaron la prueba del test timed up and go y la escala de Tinetti. Resultados. Participaron en este estudio 32 adultos mayores (79,9±8,2 años), 14 no tenían capacidad de marcha. En relación con el tiempo de ejecución del test TUG, la media fue de 45,07±28,18s, y de 8,8±8,1 puntos para la escala de Tinetti. De los 28 sujetos que tenían condiciones patológicas, 22 tenían hipertensión. En este estudio, el 80% de los sujetos se habían caído y la mitad de los ingresos se debió a las consecuencias de las caídas. La pérdida del equilibrio fue la causa principal de las caídas y las fracturas del fémur fueron el resultado más frecuente de estas. Las razones principales para la institucionalización fueron el ictus y las fracturas de fémur. Conclusiones. Hay una alta prevalencia de caídas entre las personas de edad en un sistema sociosanitario. Muchas personas están ingresadas debido a las caídas que han tenido como causa principal la falta de equilibrio(AU)

Introduction. The aim of this study was to evaluate certain conditions such as balance and functional mobility and the prevalence of falls and related factors in the elderly who are admitted to a health care system and who are undergoing rehabilitation. Method. We carried out a cross-sectional study of individuals over 65 belonging to our hospital. The timed up and go test and the Tinetti scale were performed in those who were able to walk with or without assistance. Results. In this study, 32 elderly (79.9±8.2) years, 14 of whom had no ability to walk. Regarding the time of up and go test, the average was 45.07±28.18seconds, and 8.8±8.1 points for Tinetti scale. Of the 28 subjects with medical conditions, 22 had hypertension. In this study, 80% of subjects had fallen and half of the admissions were caused by falls. The main reasons for institutionalization were stroke and femur fractures. Conclusions. There is a high prevalence of falls among the elderly in a health care system. Many of those admitted were because of falls, these basically caused by lack of balance(AU)

Hepatotoxicidad por metformina / Metformin-associated hepatotoxicity

La metformina es un antidiabético oral de la familia de las biguanidas que se utiliza ampliamente en el tratamiento de pacientes con diabetes de tipo 2. Sus principales efectos secundarios son alteraciones inespecíficas gastrointestinales (10-30%). La acidosis láctica es el efecto secundario más grave, por lo que no debe administrarse a los pacientes con insuficiencia renal, hepática o cardiovascular grave. Se ha descrito de forma excepcional hepatotoxicidad por este fármaco. Presentamos el caso clínico de una paciente con diabetes mellitus de tipo 2 e inicio reciente de tratamiento con metformina que desarrolló un cuadro de hepatotoxicidad grave que siguió una evolución posterior favorable (AU)

Metformin is an oral biguanide widely used in the management of patients with type 2 diabetes. It produces non-specific gastrointestinal symptoms in 10-30% of the patients. Lactic acidosis is the most serious side effect, so it must not be administered to patients with renal, liver, or heart insufficiency. Only a few cases of hepatotoxicity due to this drug have been documented. We report the case of a patient with type 2 diabetes mellitus and recent use of metformin who developed serious liver injury, followed by a favorable evolution (AU)

Programa rehabilitador integral del raquis cervical. Descripción, resultados y análisis de costes / Integral rehabilitation neck program. Description, outcome and cost analysis

Introducción. La cervicalgia mecánica crónica es la segunda causa de consulta en nuestros centros de atención primaria. La alta demanda de recursos que genera nos plantea introducir estrategias de gestión que sean eficaces y eficientes. Para ello diseñamos un programa de tratamiento integral del raquis (PIR) cervical, que optimiza los recursos disponibles. El objetivo del estudio es demostrar su efectividad. Material y método. Estudio prospectivo y de costes de pacientes que han participado en el PIR cervical de septiembre de 2008 a enero de 2009. Son 208 pacientes, 33 hombres y 175 mujeres, de 25–89 años. El programa es multidisciplinario y consta de 14 sesiones grupales de 1h de duración, incluyendo 2 charlas educativas (psicólogo y médico rehabilitador). Las variables recogidas son edad, sexo, escala visual analógica de dolor pretratamiento y postratamiento, y cuestionario de Northwick Park pretratamiento y postratamiento. Resultados. Disminuye un 50% las visitas y un 40% las horas de tratamiento fisioterapéutico, aunque se ha necesitado una inversión inicial única en equipamiento. La disminución del dolor mediante escala visual analógica y la mejora de la funcionalidad mediante el cuestionario de Northwik Park han sido altamente significativas desde el punto de vista estadístico. Conclusión. El PIR cervical se ha demostrado útil en la gestión de los recursos disponibles para el tratamiento del dolor cervical crónico (AU)

Introduction. Chronic mechanical neck pain is the second cause of consultation in our primary care centers. The high demand for resources generated for it, leading us introduce management strategies that are effective and efficient. For this reason, we designed an integral neck program (PIR), which optimizes available resources, and the aim of this study is demonstrate their effectiveness. Material and methods. Prospective and cost analysis study of patients who have participated in the PIR cervical, from September 2008 to January 2009. Are 208 patients, 33 men and 175 women aged 25 to 89 years. The program is multidisciplinary and consists of 14 group sessions of 1h, including 2 educational lectures (psychologist and rehabilitation physician). As variables are set age, sex, pain Visual Analog Scale (VAS) pre-and post-treatment and Northwick Pack Neck Pain Questionnaire before and after treatment. Results. We have decreased visits by 50% and 40% the hours of physiotherapy, but has needed a single initial investment in equipment. The decrease in pain by VAS and improved functionality through the Northwik Park Neck Pain Questionnaire have been highly significant statistically. Conclusion. The integral rehabilitation Neck Program is useful in the management of the resources available for the treatment of chronic neck pain (AU)