Neonatal treatment with fluoxetine alters locomotor activity and the cortical glial/neuron index in rats with cerebral palsy.

Cerebral palsy (CP) is characterized by motor disorders, including deficits in locomotor activity, coordination, and balance. Selective serotonin reuptake inhibitors have been shown to play an important role in brain plasticity. This study investigates the effect of neonatal treatment using fluoxetine on locomotor activity and histomorphometric parameters of the primary somatosensory cortex (S1) in rats submitted to an experimental model of CP. CP was found to reduce bodyweight and locomotion parameters and also to increase the glia/neuron index in the S1. Administration of fluoxetine 10 mg/kg reduced bodyweight, impaired locomotor activity parameters, and increased the number of glial cells and the glia/neuron ratio in the S1 in rats with CP. However, treatment with fluoxetine 5 mg/kg was not found to be associated with adverse effects on locomotor activity and seems to improve histomorphometric parameters by way of minor changes in the S1 in animals with CP. These results thus indicate that experimental CP, in combination with the use of a high dose of fluoxetine (10 mg/kg), impairs locomotor and histomorphometric parameters in the S1, while treatment with a low dose of fluoxetine (5 mg/kg) averts the negative outcomes associated with a high dose of fluoxetine in relation to these parameters but produces no protective effect.

The value of sentinel lymph-node biopsy in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy: a systematic review

Purpose To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. Methods The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. Results Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11–0.17), the pooled SLNIR was 0.89 (95% CI 0.86–0.92), NPV was 0.83 (95% CI 0.79–0.87), and summary accuracy was 0.92 (95% CI 0.90–0.94). SLNB performed better when more than one node was removed and double mapping was used. Conclusions SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer (AU)

m.4216 T > C polymorphism in JT cluster determines a lower pregnancy rate in response to controlled ovarian stimulation treatment.

PURPOSE: To analyze the influence of Caucasian mitochondrial haplogroups on controlled ovarian stimulation outcome (COS), embryo (E), and pregnancy success. METHODS: In a Caucasian population (n = 517) undergoing COS, mitochondrial haplogroups and physiological parameters were determined. Patients were classified, according to Bologna criteria, as good (>3)/poor ≤3) responder, on dependence of recruited oocytes (RO), and in pregnancy/non-pregnancy groups. Haplogroups were determined by sequencing mitochondrial hypervariable sequence I and confirmed by polymerase chain reaction (PCR), followed by restriction fragment length polymorphisms (RFLP). RESULTS: The rank of total dose of FSH (TD FSH) was similar in all clusters/haplogroups, except in JT, which is narrower (950-3,650 IU), particularly in T (1,350-3,650 IU). The statistical analysis showed higher RO and E in JT when compared to U, although it was only Uk which accumulated significantly in pregnancy respect to JT. Pearson's correlations between TD FSH and RO showed negative statistical significance in all population (P = 0.001), H (P = 0.03), JT (P = 0.01), and T (P = 0.03). The percentage of contribution of TD FSH on RO was almost nine times in the JT cluster as compared to all population one. CONCLUSIONS: JT cluster shows a different influence of TD FSH on RO. JT cluster shows higher RO and E than U, but it is Uk which exhibits a significant higher pregnancy rate than JT. The negative influence of the JT cluster on pregnancy success strongly suggests that the m.4216 T > C polymorphism could be responsible.

The value of sentinel lymph-node biopsy in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy: a systematic review.

PURPOSE: To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. METHODS: The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. RESULTS: Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11-0.17), the pooled SLNIR was 0.89 (95% CI 0.86-0.92), NPV was 0.83 (95% CI 0.79-0.87), and summary accuracy was 0.92 (95% CI 0.90-0.94). SLNB performed better when more than one node was removed and double mapping was used. CONCLUSIONS: SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer.

Intensive grassland management disrupts below-ground multi-trophic resource transfer in response to drought.

Modification of soil food webs by land management may alter the response of ecosystem processes to climate extremes, but empirical support is limited and the mechanisms involved remain unclear. Here we quantify how grassland management modifies the transfer of recent photosynthates and soil nitrogen through plants and soil food webs during a post-drought period in a controlled field experiment, using in situ 13C and 15N pulse-labelling in intensively and extensively managed fields. We show that intensive management decrease plant carbon (C) capture and its transfer through components of food webs and soil respiration compared to extensive management. We observe a legacy effect of drought on C transfer pathways mainly in intensively managed grasslands, by increasing plant C assimilation and 13C released as soil CO2 efflux but decreasing its transfer to roots, bacteria and Collembola. Our work provides insight into the interactive effects of grassland management and drought on C transfer pathways, and highlights that capture and rapid transfer of photosynthates through multi-trophic networks are key for maintaining grassland resistance to drought.

The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview

PurposeWe conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs.MethodsMEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews.ResultsSix systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13–14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes.ConclusionsIt would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. (AU)

The value of sentinel lymph-node biopsy after neoadjuvant therapy: an overview.

PURPOSE: We conducted a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) after the neoadjuvant chemotherapy, compared to axillary lymph-node dissection, in terms of false-negative rate (FNR) and sentinel lymph-node identification rate (SLNIR), sensitivity, negative predictive value (NPV), need for axillary lymph-node dissection (ALND), morbidity, preferences, and costs. METHODS: MEDLINE, Embase, Scopus, and The Cochrane Library were searched. We assessed the quality of the included systematic reviews using AMSTAR2 tool, and estimated the degree of overlapping of the individual studies on the included reviews. RESULTS: Six systematic reviews with variable quality were selected. We observed a very high overlapping degree across the included reviews. The FNR and the SLNIR were quite consistent (FNR 13-14%; SLNIR ~ 90% or higher). In women with initially clinically node-negative breast cancer, the FNR was better (6%), with similar SLNIR (96%). The included reviews did not consider the other prespecified outcomes. CONCLUSIONS: It would be reasonable to suggest performing an SLNB in patients treated with NACT, adjusting the procedure to the previous marking of the affected lymph node, using double tracer, and biopsy of at least three sentinel lymph nodes. More well-designed research is needed. PROSPERO registration number: CRD42020114403.

Local stability properties of complex, species-rich soil food webs with functional block structure.

Ecologists have long debated the properties that confer stability to complex, species-rich ecological networks. Species-level soil food webs are large and structured networks of central importance to ecosystem functioning. Here, we conducted an analysis of the stability properties of an up-to-date set of theoretical soil food web models that account both for realistic levels of species richness and the most recent views on the topological structure (who is connected to whom) of these food webs. The stability of the network was best explained by two factors: strong correlations between interaction strengths and the blocked, nonrandom trophic structure of the web. These two factors could stabilize our model food webs even at the high levels of species richness that are typically found in soil, and that would make random systems very unstable. Also, the stability of our soil food webs is well-approximated by the cascade model. This result suggests that stability could emerge from the hierarchical structure of the functional organization of the web. Our study shows that under the assumption of equilibrium and small perturbations, theoretical soil food webs possess a topological structure that allows them to be complex yet more locally stable than their random counterpart. In particular, results strongly support the general hypothesis that the stability of rich and complex soil food webs is mostly driven by correlations in interaction strength and the organization of the soil food web into functional groups. The implication is that in real-world food web, any force disrupting the functional structure and distribution pattern of interaction strengths (i.e., energy fluxes) of the soil food webs will destabilize the dynamics of the system, leading to species extinction and major changes in the relative abundances of species.

Variants Ala307Ala and Ser680Ser of 307 and 680 FSHr polymorphisms negatively influence on assisted reproductive techniques outcome and determine high probability of non-pregnancy in Caucasian patients.

PURPOSE: To determine the influence of different genotypes of Ala307Thr and Asn680Ser FSHr polymorphisms on controlled ovarian stimulation (COS) outcome and pregnancy. METHODS: This study collected blood and physiological and clinical parameters of 517 Caucasian patients (Statistical power ≥ 80%) that underwent COS treatment. Genotypes of Ala307Thr and Asn680Ser polymorphisms were determined using PCR amplification followed by Bsu36I and BsrI digestion, respectively. RESULTS: Ala307Ala and Ser680Ser genotypes associated to worse parameters of COS outcome (preovulatory follicles P = 0.05, in both), justifying their lower pregnancy rate than Non-Ala307Ala, P = 0.01 and Non-Ser680Ser, P = 0.004, respectively or together, (P = 0.003). Within the Non-Ala307Ala group, Thr307Thr genotype showed higher number of fertilized oocytes (P = 0.04) and embryos (P = 0.01) than Non-Thr307Thr, but no influence on pregnancy rate. Ala307Ala and Ser680Ser patients doubled probability of non-pregnancy than Non-Ala307Ala (odds ratio = 2.0) and Non-Ser680Ser (odds ratio = 2.11), respectively. Ala307Ala and Ser680Ser genotypes tend to appear together (P < 0.0001), which increases the probability of non-pregnancy. CONCLUSIONS: Ala307Ala and Ser680Ser genotypes of 307 and 680 FSHr polymorphisms associate to worse COS outcome than its respective Non-Ala307Ala and Non-Ser680Ser. Within the Non-Ala307Ala genotypes, Thr307Thr, although shows higher Fertilized Oocytes and Embryos, do not influence on pregnancy rate. Ala307Ala and Ser680Ser genotypes double the probability of Non-Pregnancy than their respective Non-Ala307Ala and Non-Ser680Ser genotypes. Furthermore, the strong tendency of these genotypes to appear together worsens the probability of pregnancy in these patients.

Pancreatitis aguda en carcinoma de célula pequeña de pulmón (CPCP) resuelta con quimioterapia / Acute pancreatitis in small-cell lung carcinoma (SCLC) resolved with chemotherapy

Resumen El carcinoma de célula pequeña (CPCP) o microcítico de pulmón es un subtipo de cáncer de pulmón que típicamente se ha asociado al tabaquismo y que se caracteriza por su agresividad y mal pronóstico a corto plazo. Como entidad, puede metastatizar en cualquier órgano, siendo las metástasis pancreáticas raras y la mayoría de las veces asintomáticas. Por ello, la presencia de una pancreatitis neoplásica, como en el caso presentado, es excepcional, y aún más cuando presenta refractariedad al tratamiento médico convencional y responde al tratamiento citotóxico sistémico. Por todo ello, se expone esta experiencia clínica y se debate la presencia de esta rara entidad y su manejo.

Abstract Small-cell lung carcinoma is a subtype of neoplasm that has been typically associated with smoking; it is characterized by its aggressiveness and poor prognosis in the short term. As an entity, it can metastasize in any organ, but pancreatic metastases are rare and most of the time asymptomatic. Therefore, the presence of neoplastic pancreatitis as in our case is exceptional; even more when it presents refractoriness to conventional medical treatment, responding instead to systemic cytotoxic treatment. Therefore, we expose our clinical experience and discuss the presence of this rare entity and its management.

Drought decreases incorporation of recent plant photosynthate into soil food webs regardless of their trophic complexity.

Theory suggests that more complex food webs promote stability and can buffer the effects of perturbations, such as drought, on soil organisms and ecosystem functions. Here, we tested experimentally how soil food web trophic complexity modulates the response to drought of soil functions related to carbon cycling and the capture and transfer below-ground of recent photosynthate by plants. We constructed experimental systems comprising soil communities with one, two or three trophic levels (microorganisms, detritivores and predators) and subjected them to drought. We investigated how food web trophic complexity in interaction with drought influenced litter decomposition, soil CO2 efflux, mycorrhizal colonization, fungal production, microbial communities and soil fauna biomass. Plants were pulse-labelled after the drought with 13 C-CO2 to quantify the capture of recent photosynthate and its transfer below-ground. Overall, our results show that drought and soil food web trophic complexity do not interact to affect soil functions and microbial community composition, but act independently, with an overall stronger effect of drought. After drought, the net uptake of 13 C by plants was reduced and its retention in plant biomass was greater, leading to a strong decrease in carbon transfer below-ground. Although food web trophic complexity influenced the biomass of Collembola and fungal hyphal length, 13 C enrichment and the net transfer of carbon from plant shoots to microbes and soil CO2 efflux were not affected significantly by varying the number of trophic groups. Our results indicate that drought has a strong effect on above-ground-below-ground linkages by reducing the flow of recent photosynthate. Our results emphasize the sensitivity of the critical pathway of recent photosynthate transfer from plants to soil organisms to a drought perturbation, and show that these effects may not be mitigated by the trophic complexity of soil communities, at least at the level manipulated in this experiment.

Genotype and phenotype landscape of MEN2 in 554 medullary thyroid cancer patients: the BrasMEN study.

Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant genetic disease caused by RET gene germline mutations that is characterized by medullary thyroid carcinoma (MTC) associated with other endocrine tumors. Several reports have demonstrated that the RET mutation profile may vary according to the geographical area. In this study, we collected clinical and molecular data from 554 patients with surgically confirmed MTC from 176 families with MEN2 in 18 different Brazilian centers to compare the type and prevalence of RET mutations with those from other countries. The most frequent mutations, classified by the number of families affected, occur in codon 634, exon 11 (76 families), followed by codon 918, exon 16 (34 families: 26 with M918T and 8 with M918V) and codon 804, exon 14 (22 families: 15 with V804M and 7 with V804L). When compared with other major published series from Europe, there are several similarities and some differences. While the mutations in codons C618, C620, C630, E768 and S891 present a similar prevalence, some mutations have a lower prevalence in Brazil, and others are found mainly in Brazil (G533C and M918V). These results reflect the singular proportion of European, Amerindian and African ancestries in the Brazilian mosaic genome.

Intestinal perforation by an ingested foreign body.

OBJECTIVE: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. MATERIALS AND METHODS: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. RESULTS: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). CONCLUSION: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

OBJETIVO: Identificar os achados tomográficos sugestivos de perfuração intestinal por corpo estranho alimentar. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, quatro casos de perfuração intestinal por corpo estranho comprovados cirurgicamente, e comparados os achados tomográficos com os descritos na literatura. RESULTADOS: Nenhum dos pacientes referiu a ingestão do corpo estranho, todos tinham mais de 60 anos, três usavam prótese dentária e todos os objetos eram alongados e pontiagudos. Os quatro apresentaram abdome agudo, o corpo estranho não foi identificado pela radiografia simples em nenhum deles, e os achados tomográficos sugestivos de perfuração foram espessamento das paredes da alça intestinal (nos quatro casos), densificação da gordura mesentérica (nos quatro casos), identificação do corpo estranho transfixando a parede intestinal (em três casos) e gás na cavidade peritoneal (em um caso). CONCLUSÃO: Perfuração intestinal é mais comum em casos de objetos pontiagudos e alongados, em que os pacientes, geralmente, não referem a ingestão, mas deve-se suspeitar em idosos que usam próteses dentárias. A tomografia permite detectar corpos estranhos, localizar a perfuração e orientar o tratamento. Os achados que sugerem perfuração são espessamento das paredes de um segmento intestinal, edema da gordura mesentérica e, menos frequentemente, gás na cavidade peritoneal, muitas vezes limitado ao ponto da perfuração.

Métodos empleados y motivos para dejar de fumar de los exfumadores / Methods used and former smokers’ reasons for giving up smoking

Objetivo: conocer el proceso de deshabituación, los métodos empleados para dejar de fumar y los motivos para ello de los exfumadores. Diseño : estudio observacional descriptivo, basado en entrevistas personales. Emplazamiento : área de salud de Toledo. Participantes : exfumadores mayores de 18 años. Mediciones principales : se recogieron variables sociodemográficas, de consumo de tabaco (edad de inicio, índice tabáquico, intentos de abandono y duración de la abstinencia), métodos de deshabituación utilizados (farmacológicos o no), motivo principal del abandono, problemas tras el abandono, grado de esfuerzo e intención de volver a fumar . Resultados : muestra final de 393 exfumadores (59,8 % varones), con edad media de 51,3 años (DE 13,7). La edad media de inicio del consumo de tabaco fue 16,4 años (3,7) y la de abandono 42,4 años (12,9). El 54,7 % (IC95 %: 49,8-59,6) había realizado algún intento previo de deshabituación. El fármaco más utilizado fue la nicotina (8,1%). El 72,5% (IC95 %: 68,1-76,9) no utilizó nunca ningún método. Esta cifra es del 78,9 % en el último intento. Las variables sexo (varón), tiempo de abstinencia (>10 años) e índice tabáquico (<30) son factores de riesgo de dejar de fumar sin ayuda. El motivo fundamental que alegan para dejar de fumar es la prevención de enfermedades (35,2 %) y la presencia de problemas físicos (26,3 %). Al 32,7 % de los entrevistados dejar de fumar no le supuso ningún esfuerzo. Un 48,8 % reconoce haber tenido algún problema tras dejar de fumar. El 63,4 % no echa de menos el tabaco. Conclusiones: El abandono del hábito se produce tras 26 años de consumo y varios intentos. La mayoría no utilizó ningún método para abandonar el hábito. Los motivos tienen que ver sobre todo con la presencia de problemas físicos y la prevención de enfermedades (AU)

Objective: to establish the process involved in breaking the smoking habit, the methods used to give up smoking and former smokers’ reasons for doing so. Design: observational study based on face-to-face interviews. Location: Toledo healthcare area. Participants: former smokers over 18 years of age. Main analysed data: socio-demographic variables in tobacco consumption, (starting age, smoking index, attempts at giving up and duration of abstinence), habit-breaking methods used (whether pharmacological or not), main reason for giving up, degree of effort and intention to smoke again. Results: final sample of 393 former smokers (59.8% male), average age 51.3 years (DE 13.7). The average starting age for tobacco consumption was 16,4 years (3.7) and 42,4 years (12.9) for giving up. 54.7% (IC95%: 49,8-59,6) had made a previous attempted at giving up. Th most widely used drug was nicotine (8,1%). 72.5% (IC95%: 68,1-76,9) never used any specific method. This figure is 78.9% at the last attempt. Variables in sex (male), time of abstinence (>10 years) and smoking index (<30) are risk factors in stopping smoking. The main reasons given for breaking the habit are disease prevention (35.2%) and the presence of physical problems (26.3%). In the case of 32.7% of those interviewed, no effort was required to cease smoking. 48.8% acknowledge experiencing some problems on giving it up. 63.4% do not miss the smoking habit. Conclusions: smoking cessation occurs after 26 years and several attempts. The majority did not use any specific method to give up the habit. Reasons are related above all to the presence of physical problems disease prevention (AU)

Heated relations: temperature-mediated shifts in consumption across trophic levels.

A rise in temperature will intensify the feeding links involving ectotherms in food webs. However, it is unclear how the effects will quantitatively differ between the plant-herbivore and herbivore-carnivore interface. To test how warming could differentially affect rates of herbivory and carnivory, we studied trophic interaction strength in a food chain comprised of green algae, herbivorous rotifers and carnivorous rotifers at 10, 15, 20 and 25°C. We found significant warming-induced changes in feeding by both herbivorous and carnivorous rotifers, but these responses occurred at different parts of the entire temperature gradient. The strongest response of the per capita herbivore's ingestion rate occurred due to an increase in temperature from 15 to 20°C (1.9 fold: from 834 to 1611 algal cells per h(-1)) and of the per capita carnivore's ingestion rate from 20 to 25°C (1.6 fold: from 1.5 to 2.5 prey h(-1)). Handling time, an important component of a consumer's functional response, significantly decreased from 15 to 20°C in herbivorous rotifers. In contrast, it decreased from 20 to 25°C in carnivorous rotifers. Attack rates significantly and strongly increased from 10 to 25°C in the herbivorous animals, but not at all in the carnivores. Our results exemplify how the relative forces of top-down control exerted by herbivores and carnivores may strongly shift under global warming. But warming, and its magnitude, are not the only issue: If our results would prove to be representative, shifts in ectotherm interactions will quantitatively differ when a 5°C increase starts out from a low, intermediate or high initial temperature. This would imply that warming could have different effects on the relative forces of carnivory and herbivory in habitats differing in average temperature, as would exist at different altitudes and latitudes.

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Necesidades formativas en la atención a pacientes oncológicos en Castilla-La Mancha / Training needs in the care of oncological patients

Objetivo Conocer las necesidades formativas en la atención a pacientes con cáncer. Método Estudio descriptivo transversal, basado en encuesta a médicos de cupo que trabajan en los centros de salud de Castilla-La Mancha. La encuesta fue diseñada ad hoc e incluía variables sobre necesidades formativas en la atención a pacientes con cáncer, en fase terminal y supervivientes (en escala de 0 a 5), seguridad en el manejo de estos pacientes, opinión sobre quién debería asumir el cuidado de estos enfermos, grado de comunicación con el oncólogo y la Unidad de Cuidados Paliativos, e implicación en la atención a los pacientes. Para el análisis se utilizó el test de Chi-cuadrado de Pearson, la t de Student y el coeficiente de correlación rho de Spearman. Resultados Respondieron 172 médicos (14,9% de la población); 51,2% varones; edad media 49,1 años. La media de pacientes terminales atendidos al año es 3,9.Las mayores necesidades formativas sentidas se refieren a la atención a supervivientes (3,44). El aspecto más reclamado es la atención a urgencias terminales (3,77). En general, la mujer tiene mayor percepción de necesidades formativas (3,44 vs. 3,21; p = 0,045). El 69,2% ha realizado algún curso en los últimos 5 años. La seguridad en el manejo de oncológicos es calificada como «media» por el 74,4% y se relaciona inversamente con la necesidad de formación, siendo mayor en (..) (AU)

Objective To determine the training required in the care of cancer patients .Method A cross-sectional study was performed, based on survey of family doctors in Health Centres of Castilla-La Mancha, Spain. The survey was designed ad hoc and included questions about training needs in caring for cancer patients, in terminal phase and survivors (level 0-5), safety management, opinion about who should care for these patients, communication with oncologist and palliative care unit, and involvement in oncological patient care. For statistical analysis we used Pearson Chi-square, Student t test and Spearman's rho coefficient. Results A total of 172 doctors responded (14.9% of the population) with a mean age of 49.1 years and 51.2% were male. The mean number of terminals patients per year was 3.9.The most required training need was related to care for survivors (3.44). Better care for emergency terminal patients (3.77) was one of the most mentioned. In general, women had a greater perception of training needs (3.44 vs. 3.21; P=.045). Over two-thirds (69.2%) has attended a training (..) (AU)

La consulta preconcepcional en el Área de Salud de Toledo / Pre-conception consultation in the Toledo healthcare area

Objetivo. Conocer el porcentaje de mujeres que han realizado consulta preconcepcional (CPC), los motivos de dicha consulta y las intervenciones realizadas. Diseño. Estudio observacional descriptivo, basado en entrevistas personales. Emplazamiento. Atención Primaria. Participantes. 465 mujeres con embarazo a término en los últimos doce meses. Mediciones principales. Realización de CPC, motivos, profesionales consultados, consulta privada o pública y actividades realizadas (exploración física, ginecológica, pruebas de laboratorio, citología, estudio genético, vacunaciones, consejo sanitario, quimioprofilaxis). Resultados. El 69,2% de los embarazos fue planificado. El 23,9% de las entrevistadas realizó CPC (IC95% 20,0-27,7). La CPC fue más frecuente en primíparas, mayores de 30 años, españolas y universitarias (p<0,05). El motivo más habitual de CPC fue la prevención de problemas (40,8%). El 63,1% utilizó el sistema público, el 31,1% la privada y el 5,8% ambos. El profesional más consultado fue el médico de familia (60,2%). Las actividades más frecuentemente realizadas fueron: quimioprofilaxis (94,2%), consejo sanitario (82,5%), analítica (68,9%), citología (66,0%), exploración física (55,3%) y ginecológica (44,7%). Sólo hubo un 9,7% de vacunaciones. Existen diferencias entre las actividades realizadas en el sistema público y la medicina privada. Conclusiones. El porcentaje de embarazos planificados es mayor de lo esperado, al igual que el de mujeres que realizaron CPC, probablemente por una mayor concienciación de la mujer. Los motivos son básicamente preventivos, por encima de la existencia de factores de riesgo o enfermedades crónicas. Hay un uso importante de la medicina privada. No existe una actuación homogénea en las actividades realizadas. Tanto la quimioprofilaxis como las vacunaciones son en general bajas (AU)

Objective: Ascertain the percentage of women who have made a pre-conception consultation, the reasons for the consultation and interventions carried out. Design: Observational descriptive-type study based on personal interviews. Location: Primary healthcare. Participants: 465 women with term pregnancies in the last twelve months. Main Surveyed Data: Having pre-conception consultation (PCC), reasons, professionals consulted, private or public practice, activities carried out (physical or gynaecological examination, laboratory tests, pap smear, genetic study, vaccinations, healthcare advice, chemoprophylaxis) Results: 69.2% of pregnancies were planned. 23.9% of those interviewed made a pre-conception consultation (IC95% 20.0-27.7). PCC was most frequent in first-time mothers over 30 years old, of Spanish nationality and with a university degree (p<0.05). The most common reason for a PCC was the prevention of problems (40.8%). 63.1% used public health services, 31.1% private health and 5.8%, both. The most consulted professional was the family doctor (60.2%). The most frequent activities were: chemoprophylaxis (94.2%), healthcare advice (82.5%), analysis (68.9%), pap smear (66.0%), physical examination (55.3%) and gynaecological examination (44.7%). Vaccinations represented only 9.7%. There are differences between activities carried out in public and private health practices. Conclusions: The percentage of planned pregnancies is higher than expected, as was the number of women having PCC, probably due to a greater awareness. The reasons are basically preventive, above the existence of risk factors or chronic illness. There is considerable use of private medicine. There is no unified procedure in activities carried out. Both chemoprophylaxis and vaccination are low (AU)

Los pacientes con reacciones adversas a medicamentos presentan una mayor prevalencia de alteraciones emocionales / Patients with adverse drug reactions have a higher prevalence of emotional disorders

Objetivo: Examinar la frecuencia de alteraciones emocionales (ansiedad y depresión) en pacientes con reacciones adversas (RA) a medicamentos, y compararla con la que se da en pacientes sin las mismas. Diseño del estudio: Casos y controles. Emplazamiento: Centro de Salud de Santa María de Benquerencia (Toledo). Participantes: Pacientes mayores de 14 años de ambos sexos de una consulta de medicina de familia. Mediciones y resultados: El total de pacientes fue de 311 (108 casos y 203 controles), siendo el 53,7% varones. La edad de los casos fue de 54,1 años y la de los controles 46,0 (t=4,254; p<0,001). El 45,5% de los casos presentaba antecedentes de ansiedad y el 41,7% de depresión, frente al 19,7 y 15,3%, respectivamente, de los controles (p<0,001). El promedio de enfermedades crónicas en casos fue de 5,8 y en controles 3,5 (p<0,001). El número de medicamentos tomados para los casos fue de 3,7 y para los controles de 1,7 (p<0,001). En la regresión logística, la probabilidad de haber presentado ansiedad está aumentada 2,5 veces en los pacientes con RA a medicamentos (IC 95%: 1,12-4,51) y la de haber presentado depresión 2 veces (IC 95%: 1,06-3,66). Los grupos de medicamentos que más RA presentaron fueron los del sistema nervioso central, los antibióticos y los antiinflamatorios. Conclusiones: 1) La comunicación de RA a medicamentos se asocia con la presencia de ansiedad o depresión, lo cual podría usarse como marcador de problemática psicosocial. 2) Debemos prestar atención a los pacientes con ansiedad o depresión a la hora de realizar prescripciones. 3) Los antibióticos, antiinflamatorios y fármacos que actúan en el sistema nervioso central son los más proclives a producir RA(AU)

Aim: To examine the frequency of emotional disorders (anxiety and depression) in patients with adverse drug reactions (ADR), compared with that in patients without those disorders. Study design: Case-control. Setting: Santa María de Benquerencia Health Centre (Toledo).ParticipantsPatients over 14 years old of both sexes managed in a Primary Care Clinic. Measurements and results: A total of 311 patients (108 cases and 203 controls) were included, of whom 53.7% were male. The mean age was 54.1 years in cases, and 46.0 in controls (t=4.254; P<0.001). Antecedents of anxiety were presented in 45.5% of cases, and those of depression in 41.7%, versus 19.7% and 15.3%, respectively, in controls (P<0.001). Mean chronic illnesses were 5.8 in cases and 3.5 in controls (P<0.001). Mean number of drugs consumed was 3.7 in cases and 1.7 in controls (P<0.001). In the logistic regression, the probability of having had anxiety was 2.5 times higher in patients with ADR (95%CI 1.12-4.51), and the probability of having had depression was twice as likely (1.06-3.66). Drug groups with a higher number of ADR were those of the central nervous system, antibiotics and antiinflammatories. Conclusions: 1) ADR is associated with anxiety and depression, and it can be used as a marker of social issues. 2) Attention must be paid to patients with anxiety or depression when making out prescriptions. 3) Antibiotics, antiinflammatories and drugs acting on the central nervous system are more likely to produce ADR(AU)

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