Prevalence of Systemic Lupus Erythematosus in Spain: Higher than Previously Reported in other Countries?

[Abstract] Objectives: Prevalence of SLE varies among studies, being influenced by study design, geographical area and ethnicity. Data about the prevalence of SLE in Spain are scarce. In the EPISER2016 study, promoted by the Spanish Society of Rheumatology, the prevalence estimate of SLE in the general adult population in Spain has been updated and its association with sociodemographic, anthropometric and lifestyle variables has been explored. Methods: Population-based multicentre cross-sectional study, with multistage stratified and cluster random sampling. Participants were contacted by telephone to carry out a questionnaire for the screening of SLE. Investigating rheumatologists evaluated positive results (review of medical records and/or telephone interview, with medical visit if needed) to confirm the diagnosis. To calculate the prevalence and its 95% CI, the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. Multivariate logistic regression models were defined to analyse which sociodemographic, anthropometric and lifestyle variables included in the telephone questionnaire were associated with the presence of SLE. Results: 4916 subjects aged 20 years or over were included. 16.52% (812/4916) had a positive screening result for SLE. 12 cases of SLE were detected. The estimated prevalence was 0.21% (95% CI: 0.11, 0.40). SLE was more prevalent in the rural municipalities, with an odds ratio (OR) = 4.041 (95% CI: 1.216, 13.424). Conclusion: The estimated prevalence of SLE in Spain is higher than that described in most international epidemiological studies, but lower than that observed in ethnic minorities in the United States or the United Kingdom

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Actinomicosis Orofaríngea, una Presentación Cervicofacial

La Actinomicosis es una enfermedad producida por Actinomyces Israelii y Proprinibacterium, afecta con mayor frecuencia a hombres adultos y puede adoptar diversas formas: cervicofacial, torácica, abdominal y pélvica. La afectación cervicofacial puede cursar como una leve tumoración, como un absceso o como una masa, pero no siempre se diagnostica con facilidad, y de hecho, con frecuencia es confundida con neoplasias o enfermedades granulomatosas. El diagnóstico se obtiene a partir de los hallazgos microbiológicos e histológicos.Se presenta el caso de un paciente de sexo masculino de 67 años, con dolor constante en orofaringe de algunos meses de evolución, que le impedía la ingesta de alimentos. Al examen físico presentaba lengua saburral, secreción lingual con gránulos pequeños de color amarillo, lesión indurada orofaríngea y numerosas lesiones diseminadas de 3 mm de diámetro aproximadamente en piel de manos, abdomen y miembros inferiores llegándose al diagnóstico de actinomicosis procediéndose con el tratamiento adecuado

Actinomicosis Orofaríngea, una Presentación

Actinomycosis is a disease caused by Actinomyces Israelii and Proprinibacterium, most often affects adult men and may take several forms: cervicofacial, thoracic, abdominal and pelvic. Cervicofacial involvement may appear as a mild tumor, like an abscess or a mass, but is not always easily diagnosed, and in fact, is often mistaken for malignancy or granulomatous disease. The diagnosis was obtained through microbiological and histological findings. A male patient, aged 67, had constant pain in the oropharynx for some months, which prevented him from eating. On examination: coated tongue, small, yellow lingual secretion granules, indurated lesion oropharyngeal and numerous disseminated lesions, of 3 mm in diameter on the skin of the hands, abdomen and lower limbs; with the correct diagnosis we can start appropriate treatment.La Actinomicosis es una enfermedad producida por Actinomyces Israelii y Proprinibacterium, afecta con mayor frecuencia a hombres adultos y puede adoptar diversas formas: cervicofacial, torácica, abdominal y pélvica. La afectación cervicofacial puede cursar como una leve tumoración, como un absceso o como una masa, pero no siempre se diagnostica con facilidad, y de hecho, con frecuencia es confundida con neoplasias o enfermedades granulomatosas. El diagnóstico se obtiene a partir de los hallazgos microbiológicos e histológicos. Se presenta el caso de un paciente de sexo masculino de 67 años, con dolor constante en orofaringe de algunos meses de evolución, que le impedía la ingesta de alimentos. Al examen físico presentaba lengua saburral, secreción lingual con gránulos pequeños de color amarillo, lesión indurada orofaríngea y numerosas lesiones diseminadas de 3 mm de diámetro aproximadamente en piel de manos, abdomen y miembros inferiores llegándose al diagnóstico de actinomicosis procediéndose con el tratamiento adecuad

Retinopatía Diabética y otros hallazgos oftalmológicos en pacientes diabéticos, asistidos por las Fundaciones Cristo Vive y Vida Plena, Bolivia

Objectives: This study aims to present the ocular findings found in diabetic patients controlled by Fundación Cristo Vive Bolivia, in the town of Bella Vista, Quillacollo province of Cochabamba, Bolivia in February 2013. Methods: We performed a cross-sectional descriptive study. Were included in the study 28 patients with a mean age of 57 years (range 36 to 73 years) in whom we studied the presence of RD by biomicroscopy and fundus examination with dilation. We also carried out visual acuity and other ophthalmologic search. Results: Ophthalmologic most frequently encountered Hyperopia was no known association with diabetes mellitus (DM). Of all patients, in 29% RD was found in one of their presentations. As for RD patients, 62.5% had no proliferative DR, 25% of blindness and 12.5% RD proliferative DR. To determine the relationship between the time of DM and DR patients were grouped in 10-year intervals, we find that 62.5% of patients with disease of the retina is concentrated in the range of 11-20 years diagnosis of DM at the time of ophthalmologic evaluation. None of the patients with RD reached HbA1c levels expected, and even half of them increased their values in relation to a prior. Conclusions: glycemic control and duration of DM directly affect the progression of DR.Objetivos: este estudio tiene por finalidad presentar los hallazgos oftalmológicos encontrados en pacientes diabéticos controlados por la Fundación Cristo Vive Bolivia, en la localidad de Bella Vista, provincia Quillacollo de la ciudad de Cochabamba, Bolivia en febrero del 2013. Métodos: Se realiza un estudio descriptivo de corte transversal. Se incluyeron en el estudio 28 pacientes con una media de edad de 57 años (intervalo entre 36 y 73 años) en quienes se estudió la presencia de RD mediante Biomicroscopía y examen de fondo de ojo con dilatación. Además se realizó agudeza visual y la búsqueda de otras alteraciones oftalmológicas. Resultados: la alteración oftalmológica encontrada con mayor frecuencia fue la Hipermetropía sin relación conocida con la Diabetes Mellitus (DM). Del total de pacientes, en el 29% se encontró RD en alguna de sus presentaciones. En cuanto a los pacientes con RD, el 62,5% presentó RD no Proliferativa, el 25% ceguera por RD y 12,5% RD proliferativa. Para determinar la relación entre el tiempo de DM y la RD se agruparon a los pacientes en intervalos de 10 años, donde encontramos que el 62,5% de los pacientes con afección de la retina se concentraron en el intervalo de 11 a 20 años de diagnóstico de DM al momento de la evaluación oftalmológica. Ninguno de los pacientes con RD alcanzó los niveles de HbA1 esperados, e incluso la mitad de ellos aumentaron sus valores con relación a un control previo. Conclusiones: el control glicémico y el tiempo de evolución de la DM repercuten directamente en la progresión de la RD

VIH: transmisión Vertical y Síndrome Neurológico en Infantes

La epidemia del VIH/SIDA dejó de ser una enfermedad exclusivamente de homosexuales, para convertirse en una enfermedad que ataca al ser humano sin distinción de raza, sexo o edad. El sexo femenino está cada vez más expuesto a la infección y es capaz de transmitir el VIH a su hijo si no hay una intervención terapéutica adecuada en el período de gestación. Se han descrito tres tiempos en los cuales la transmisión vertical puede ocurrir: transmisión intraútero, transmisión intraparto, transmisión post parto vía lactancia materna. Dentro las complicaciones que presenta la transmisión madre�niño, del VIH, se presentan alteraciones neurológicas, estas pueden ser muy acentuadas y la primera manifestación es una franca detención en la evolución del crecimiento, a ello se asocia un notable retraso en el desarrollo psicomotor y pronto se establecen los síndromes de las grandes vías, que se expresan por: rigidez extra piramidal, ataxia, síndrome piramidal. Presentamos el caso clínico, de un infante de 4 meses de edad VIH positivo, transmitido de forma vertical, con neumonía, asociada a una protuberancia a nivel cefálico en la región frontal. El mismo paciente fue tratado con medidas de sostén y recuperación.The epidemic of the VIH/SIDA stopped being a disease exclusively of homosexual to turn into a disease that attacks the human being without distinction of race, sex or age. The feminine sex is increasingly exposed to the infection and is capable of transmitting the VIH to her are if there is no a therapeutic intervention adapted in the period of gestation. They have been described three times in which the vertical transmission can happen: Transmission Intraútero, Transmission Intraparto, Transmission post divide route mother lactation. Inside the complications that mother presents the transmission - child of the VIH appear neurological alterations, these can be very marked and the first manifestation is a Franc detention in the evolution of growth, with it a notable delay is associated in the psychomotor and prompt development there are established the syndromes of the big routes, which express for: Inflexibility extrapiramidal, Ataxia, Pyramidal Syndrome. Let�s sense beforehand the clinical case, of a childhood of 4 months of age positive VIH, transmitted of vertical form, with pneumonia associated with a protuberance with cephalic level in the frontal region. The same patient who was treated with happened of support and recovery

Relación de las determinantes de la salud con el estado de salud de pobladores de la zona de K´ara K´ara en Cochabamba (Bolivia) valorado a través de revisión médica

Objectives: The aim of this work was to know health status of a kara kara community and its possible relationship with social determinants of health. Methods: We made a clinical revision to people of the neighborhood of Kara kara and we took blood and urine samples from children. Results: Many variables were analyzed in relationship with determinants of health, and we found that malnutrition is one of the most important aspects that emerge together with high abort indices and pregnancy problems. Conclusions: People of Kara kara general health is affected by nutritional reproductive and psychological aspects, but the most important social determinant of health seems to be education, formal as well as health education that conditioned to nutrition and prevention behavior.Objetivos: el objetivo de ese trabajo fue indagar sobre el estado de salud valorado a través de la revisión médica de la comunidad de K´ara kara y su posible relación con las determinantes sociales de la salud. Métodos: se realizó revisión clínica a pobladores adultos y niños de dos barrios de Kara kara, y se tomaron muestras de sangre y orina a los niños. Resultados: se analizaron varias variables en relación con las determinantes sociales de la salud, y se encontró que la malnutrición es uno de los factores que sobresalen, junto al alto índice de abortos y problemas del embarazo. Conclusiones: La salud en general de los pobladores de Kara kara está afectada en los aspectos nutricional, reproductivo, psicológico y otros , pero la determinante más importante en este caso es la educación tanto formal como la educación en salud que determinan el estado nutricional y la conducta de prevención

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease