Programa de educación para la salud dirigido a adolescentes con psoriasis: El papel del estilo de vida y la nutrición

Introducción: La psoriasis es una enfermedad inflamatoria crónica de la piel de carácter autoinmune con manifestaciones sistémicas que puede afectar al buen desarrollo del adolescente. La distribución mundial es de alrededor del 2%, con una prevalencia del 2,3% en la población española suponiendo un grave problema de Salud Pública.Esta patología puede afectar de forma significativa sobre la calidad de vida del paciente, especialmente en etapas de la vida tan delicadas como es el caso de la adolescencia. El impacto físico, psicológico y social puede tener un efecto negativo en la autoimagen y autopercepción de los jóvenes llegando a crear miedo a la estigmatización e incluso conductas desadaptativas.Objetivo principal: Elaborar un programa de educación para la salud para mejorar el autocuidado en pacientes jóvenes con psoriasis enfocado en un estilo de vida saludable.Metodología: Se ha realizado una revisión bibliográfica en diferentes bases de datos científicas (Pubmed, Science Direct, Dialnet y Web of Science), se han utilizado libros y páginas web oficiales con el fin de obtener información actualizada, así como la taxonomía NANDA, NOC, NIC.Conclusiones: El papel de enfermería es clave para proporcionar a los pacientes la información adecuada y transmitir la importancia de los cuidados holísticos. Mediante la educación sanitaria y con la ayuda de medidas no farmacológicas se puede mejorar el control de la psoriasis y evitar complicaciones que afecten a la calidad de vida.Palabras clave: "psoriasis", "tratamiento", "adolescentes", "prevalencia", "calidad de vida", "imagen corporal", "enfermería"."<br /

Changes in the arrhythmic profile of patients treated for heart failure are associated with modifications in their myocardial perfusion conditions

Background: Heart failure (HF) patients can benefit from a proper RS. We had observed that they show an increase in the number of arrhythmias during the first year of pharmacological treatment. Methods: We carried out a prospective observational study in which patients in an HF Clinic were included when they had follow-up Holter monitoring. Patients also had a baseline myocardial perfusion scan (Tc99 sestaMIBI/dypiridamole) and a control scan. Results: We included 90 patients with follow-up Holter and 35 with scintigraphy, for analysis. Fifty-six (62.2%) were men and the average age was 60.8 &#177; 14.6 years. Follow-up periods were divided by six-month intervals up to 18 months or more, an increase in premature ventricular contractions (PVCs) occurred in the six-month to one-year period (1915.4 &#177; &#177; 4686.9 vs. 2959 &#177; 6248.1, p = 0.09). In the one-year to 18-month control, PVCs went from 781.6 &#177; 1082.4 to 146.9 &#177; 184.1, p = 0.05. The increase in PVCs correlated with a reduction in scintigraphy-detected ischemic territories, 5.64 &#177; 5.9 vs. 3.18 &#177; 3 (p = 0.1) and a gain in those showing a reverse redistribution pattern (0.18 &#177; 0.6 vs. 2.09 &#177; 4.01, p = 0.1). Necrotic territories and time domain heart rate variability did not show significant changes. Conclusions: PVCs increase during the first year of HF treatment, and then they tend to diminish and stabilize. These changes seem to correlate with changes in the perfusion state of the patient. While ischemic territories decrease, reverse redistribution increases, showing that endothelial dysfunction could have a relevant role in arrhythmia generation, possibly because of membrane instability of recovered hibernating myocardium. (Cardiol J 2008; 15: 261-267

The effect of left ventricular dysfunction on right ventricle ejection fraction during exercise in heart failure patients: Implications in functional capacity and blood pressure response

Background: The aim of this study was to assess the effect of left ventricular dysfunction on right ventricular ejection fraction during exercise in heart failure patients and its implications in functional capacity and blood pressure response. Methods: In a cross-sectional study 65 patients with heart failure were included. Left and right ventricular ejection fractions were evaluated by radio-isotopic ventriculography. All subjects underwent an exercise treadmill test (Bruce modified protocol). Systolic and diastolic blood pressures were also recorded. Results: From the total population, 38 (58.46%) showed a significant increase (&#8805; 5%) in left ventricular ejection fraction (LVEF) and 27 (41.5%) showed a significant decrease in LVEF (&#8805; 5%) after the stress test. Patients with a significant reduction in LVEF during stress had lower exercise tolerance (4.1 &#177; 2.5 vs. 6.1 &#177; 2.5 METs, p = 0.009) compared to those who showed an increase in LVEF. Diastolic blood pressure was higher at rest among those who had a reduced LVEF during stress (83 &#177; 12.2 vs. 72.6 &#177; 12.2 mm Hg, p = 0.035) and during exercise (95 &#177; 31.3 vs. 76.9 &#177; 31.3 mm Hg, p = 0.057), as well as mean arterial pressure in the same group (97.1 &#177; 11.6 mm Hg, p = 0.05). In addition, this group decrease of &#8211;8.8 &#177; 51.6% in the right ventricular ejection fraction after exercise compared to an increase of 27.3 &#177; &#177; 49.1% (p = 0.007) among the patients with an increase in LVEF. Conclusions: Biventricular systolic dysfunction during exercise is associated with higher rest and stress blood pressure and worse functional capacity

Microalbuminuria in systolic and diastolic chronic heart failure patients

Background: Microalbuminuria is considered a major risk factor predisposing to cardiovascular morbidity and mortality. Microalbuminuria levels in patients with or without diabetes have been associated with a higher risk of chronic heart failure (HF). However, there are limited data regarding prevalence of microalbuminuria in chronic heart failure and its prognostic value. The aim of this study was to assess the occurence of microalbuminuria in chronic heart failure patients as well as its association with clinical, echocardiographic, and body composition markers. Methods: In a cross-sectional study, we included 72 chronic heart failure patients (NYHA I-III) on standard HF therapy. All patients had an echocardiogram and body composition by vector bioelectric impedance analysis (measured by Body Stat Quad Scan). Results: The studied population consisted of 64% men at mean age of 62.6 &#177; 15.1 years. Patients were divided into systolic and diastolic HF groups. Microalbuminuria was observed in 40% of diastolic and 24% systolic HF patients (p = 0.04). Microalbuminuria was present in more patients with volume overload (80 vs. 21.9%, p = 0.002), with a worse phase angle and lower serum albumin (4.7 vs. 5.9° and 3.5 vs. 4.0 mg/dl, p = 0.02) and higher pulmonary arterial pressure compared with patients without microalbuminuria in systolic HF patients. There was no significant association between frequency of microalbuminuria and ejection fraction. In the diastolic HF group, the presence of microalbuminuria was not associated with any known risk factor. Conclusions: Microalbuminuria was more frequent in diastolic than systolic HF patients. In systolic HF patients microalbuminuria was associated with factors known to be markers of worse prognosis. (Cardiol J 2008; 15: 143-149

Reversible changes of electrocardiographic abnormalities after parathyroidectomy in patients with primary hyperparathyroidism

Background: Several studies have reported that primary hyperparathyroidism is a risk factor of higher cardiovascular mortality, mainly because hyperparathyroidism is related to arterial hypertension, arrhythmias, structural heart abnormalities and activation of the renin&#8211;angiotensin&#8211; aldosterone system. However, very few studies have shown the electrocardiographic changes that occur after parathyroidectomy. That was the aim of this study. Methods: We studied 57 consecutive patients with primary hyperparathyroidism surgically treated. Electrocardiogram, serum electrolytes, parathyroid hormone, creatinine and albumin measures were obtained before and after surgery and were compared. Results: The most common basal electrocardiographic abnormalities were left ventricular hypertrophy (LVH, 24.6%), conduction disturbances (16.3%), and short QT and QTc intervals. After surgery, a QTc interval lengthening and a tendency of T wave shortening were observed, as well as an inverse association between QTc interval and serum levels of magnesium and corrected calcium. There were no differences in LVH and conduction disturbances after surgery. Conclusions: Primary hyperparathyroidism is an important factor in the development of electrocardiographic abnormalities in this population, some of which are not corrected after parathyroidectomy. Further studies are required to demonstrate what factors are associated with persistence of electrocardiographic disturbances after surgery

Seed storage conditions change the germination pattern of clonal growth plants in Mediterranean salt marshes.

8 páginas, 4 tablas, 8 figuras.The effect of salinity level and extended exposure to different salinity and flooding conditions on germination patterns of three saltmarsh clonal growth plants (Juncus subulatus, Scirpus litoralis, and S. maritimus) was studied. Seed exposure to extended flooding and saline conditions significantly affected the outcome of the germination process in a different, though predictable, way for each species, after favorable conditions for germination were restored. Tolerance of the germination process was related to the average salinity level measured during the growth/germination season at sites where established individuals of each species dominated the species cover. No relationship was found between salinity tolerance of the germination process and seed response to extended exposure to flooding and salinity conditions. The salinity response was significantly related to the conditions prevailing in the habitats of the respective species during the unfavorable (nongrowth/nongermination) season. Our results indicate that changes in salinity and hydrology while seeds are dormant affect the outcome of the seed-bank response, even when conditions at germination are identical. Because these environmental-history-dependent responses differentially affect seed germination, seedling density, and probably sexual recruitment in the studied and related species, these influences should be considered for wetland restoration and managementFinancial support from the Spanish Ministry of the Environment (MMA, project 05/99) and the Junta de Andalucía (research group 4086)enabled us to carry out the present work.Peer reviewe

Seed storage conditions change the germination pattern of clonal growth plants in Mediterranean salt marshes.

8 páginas, 4 tablas, 8 figuras.The effect of salinity level and extended exposure to different salinity and flooding conditions on germination patterns of three saltmarsh clonal growth plants (Juncus subulatus, Scirpus litoralis, and S. maritimus) was studied. Seed exposure to extended flooding and saline conditions significantly affected the outcome of the germination process in a different, though predictable, way for each species, after favorable conditions for germination were restored. Tolerance of the germination process was related to the average salinity level measured during the growth/germination season at sites where established individuals of each species dominated the species cover. No relationship was found between salinity tolerance of the germination process and seed response to extended exposure to flooding and salinity conditions. The salinity response was significantly related to the conditions prevailing in the habitats of the respective species during the unfavorable (nongrowth/nongermination) season. Our results indicate that changes in salinity and hydrology while seeds are dormant affect the outcome of the seed-bank response, even when conditions at germination are identical. Because these environmental-history-dependent responses differentially affect seed germination, seedling density, and probably sexual recruitment in the studied and related species, these influences should be considered for wetland restoration and managementFinancial support from the Spanish Ministry of the Environment (MMA, project 05/99) and the Junta de Andalucía (research group 4086)enabled us to carry out the present work.Peer reviewe

Doñana. Acta vertebrata. vol 24(1/2)

Alimentación de la lagartija colilarga Psammodromus algirus (L) (Sauria, Lacertidae), en el litoral de Huelva (SO EspañaLa alimentación de Myotis myotis Borkh, 1791 (Chiroptera, Vespertilionidae) en la cuenca del rio Guadix (sureste de España)Distribución y selección de hábitat de la garduña (Martes foina, Erxleben, 1777) en Vizcaya y Sierra Salvada (Burgos).Nuevo modelo de trampa para reducir el impacto de la pesca de cangrejos sobre los vertebrados en las marismas del GuadalquiviThe functions of song and the spatial pattern of song production in the rufous bush chat (Cercotrichas galactotes)Migración e invernada de las lavanderas cascadena Motacilla cinerea y blanca M. alba en la Penínula Ibérica e Islas BalearesAbundancia y reproducción de Glis glis (Linnaeus, 1766) (Rodentia, Gliridae) en el Pirineo occidental.Estatus de residencia, categorización trófica y abundancia de aves en el zoológico de La Plata, ArgentinaAvifauna reproductora y estructura del hábitat en la campiña y sierras Subbéticas de JaénDispersión de semillas de retama (Retama sphaerocarpa (L.) Boiss por el conejo (Oryctolagus cuniculus L.) en el centro de EspañaGuía para la identificación de restos óseos pertenecientes a algunos peces comunes en las aguas continentales de la Península Ibérica para el estudio de la dieta de depredadores ictiófagosDistribución y abundancia del corzo (Capreolus capreolus L. 1758) en la provincia de JaénAlimentación de las larvas de anuros en ambientes temporales del sistema del rio Paraná, Argentina.Mauremys leprosa como presa de Lutra lutraNota sobre la alimentación del lince ibérico en el Parque Natural de la Sierra de Andújar (Sierra Morena oriental)Presencia de Echinococcus granulosus (Cestoda) en un lobo ibérico (Canis lupusLa orientación de los nidos de paseriformes estepariosComparación de la dieta obtenida a partir de muestras estomacales y fecales del Tuco-tuco, Ctenomys mendocinus, en dos poblaciones de la precordillera de los Andes, ArgentinaEstructura genética y distribución de la variabilidad enzimática en poblaciones naturales de estornino negro (Sturnus unicolor)Estimación de la disponibilidad trófica para el quebrantahuesos (Gypaetus barbatus) en Cataluña (NE España) e implicaciones sobre su conservaciónPeer reviewe

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response

OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE iniciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo.<br>OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances

Síncope en el anciano: Hallazgos de pruebas complementarias en un Centro Hospitalario Universitario

El síncope es un síntoma frecuente en la población adulta mayor. El diagnóstico de su etiología es esencialmente clínico, pero en casos de origen desconocido es necesario realizar estudios complementarios. Se presenta la experiencia de un centro en el diagnóstico de síncope de origen desconocido (SOD). Métodos: Se hizo un estudio transversal retrolectivo en el que se analizaron las pruebas realizadas a pacientes en estudio de SOD. Resultados: La edad promedio del grupo de mayores fue de 77.6 ± 6.9 años. Los holter de 24 horas fueron anormales en el 77.9% de los casos pero diagnósticos en 16.3%. La edad mayor a 65 años se asoció con un incremento de 1.9 veces (IC 95% 0.9 - 4) de tener diagnóstico, mientras que tener menos de 65 años se asoció con un riesgo de 0.5 para un holter diagnóstico (IC 95% 0.2 - 1.08). El holter de 48 horas mostró resultados similares. La edad mayor se asoció con un OR de 1.69, IC 95% 0.6 - 4.4 para tener una prueba de inclinación positiva (91.1% de los mayores de 65 años) para síncope neuralmente mediado, que en su mayoría era de tipo vasodepresor (57.1% vs 40.1%, p = 0.01). De los 6 estudios electrofisiológicos en mayores de 65 años, 3 fueron diagnósticos (50% vs 33.3%, p = 0.6). Conclusiones: Las pruebas complementarias para el estudio de síncope en pacientes mayores de 65 años son diagnósticas en mayor proporción que en las poblaciones más jóvenes, pero hay un riesgo de que haya más falsas positivas, por lo que pruebas como la de inclinación deben interpretarse con mayor cuidado