La calidad de vida en el síndrome del túnel del carpo: estudio prospectivo tras cirugía abierta

Se ha realizado un estudio prospectivo del grado de afectación funcional en 90 pacientes con síndrome del túnel del carpo intervenidos mediante abordaje corto palmar. Todos los pacientes eran mujeres, con edad entre 20 y 50 años, y fueron revisados con un período de seguimiento mínimo de 12 meses y completaron un cuestionario pre y postoperatoriamente sobre 12 habilidades manuales que comprendían desde el aseo personal, la lectura y escritura y las tareas domésticas. También se registró el grado de satisfacción con la cirugía y la reincorporación laboral. Preoperatoriamente, las actividades más afectadas eran aquellas que precisan fuerza o utilización de la pinza digital. Un 53.3% de los pacientes referían limitación de al menos4 actividades preoperatoriamente; sin embargo, a los 12 mese de la cirugía sólo un 4,4% referían limitación en alguna actividad. El cuestionario utilizado presentó una correlación significativa con la fuerza de la mano afecta (p=0,02) y con el signo de Tinel (p=0,04). El grado de satisfacción subjetiva fue de 9,5 puntos. La actividad laboral previa a la cirugía estaba limitada en un 86,6%. El 95,5% se reincorporó a su actividad laboral en un tiempo medio de 6,1 semanas. En Conclusión, el tratamiento quirúrgico del síndrome del túnel carpiano por cirugía abierta mediante abordaje corto palmar permite al paciente realizar las tareas cotidianas de manera casi completa, mejorando la calidad de vida percibida.A prospective study was made of 90 patients with idiopathic carpal tunnel syndrome before and after open release using a short palmar incision. All women, age between 20 and 50 years, with a postoperative follow-up of one year. They completed a questionnaire regarding preoperative and postoperative 12 activities of daily living from self-care, hygiene tasks, reading, writing and housework. They also refereed the procedure satisfaction and return to work. Preoperative, the most difficult tasks involved some type of labour. A 53.3% of the patients rated limitation in 4 activities at least.; however, 12 months after surgery only 4.4% rated limitation in one activity. The questionnaire showed a significant correlation with the grip strength p=(0.02) and Tinel sign (p=0.04). The average satisfaction with the surgery was 9.5 of 10. Preoperative 86.6% of the patients rated limitation to do their job. Average return to work was 6.1 weeks in 95.5% of the patients. In conclusion, open carpal tunnel release using a short palmar incision allow patients to manage activities of daily living almost completely and to perceive quality of life

Algunas cuestiones pendientes : evaluación de la investigación cualitativa en convocatorias competitivas. "No midas mi peso con una jarra"

La investigación cualitativa es un paradigma de la investigación científica en ciencias sociales de amplia aplicación en las ciencias de la salud. Ofrece herramientas rigurosas que permiten explicar los problemas de salud desde la perspectiva de los actores involucrados (pacientes, cuidadores y profesionales). Está ampliamente aceptada en el mundo científico sanitario internacional como válida y necesaria. Sin embargo, es necesario que los proyectos de índole cualitativa se realicen de forma creíble para lo cual se requiere de diseños rigurosos. Muchos investigadores han trabajado sobre los criterios de rigor y algunos de ellos ofrecen estrategias que potencian la realización de estudios de mejor calidad. Es necesario conocer dichos criterios para su aplicación en la evaluación de proyectos presentados en las convocatorias competitivas tanto nacionales como regionales. En este articulo se presentan las consideraciones metodológicas y conceptuales del paradigma cualitativo y las necesidades especiales que presentan los diseños cualitativos para que no se cometa la equivocación de terminar midiendo "el peso en litros y con una jarra"

Complicaciones tras el enclavado de Ender en las fracturas trocantéreas

—Se realizó el análisis de las complicaciones de 100 casos consecutivos de pacientes con fractura trocantérea del fémur intervenidos mediante clavos de Ender, con un seguimiento postoperatorio medio de 10 meses. Hubo 75 mujeres y 25 hombres, con una media de edad de 81 años. Según la clasificación de Jensen un 27% eran estables y un 73% inestables. Se obtuvieron un 32% de complicaciones y errores de técnica intraoperatorios, un 39% de migraciones distales, un 3% de migraciones proximales y un 11% de consolidaciones viciosas en varo. Todo ello se tradujo en un 21% de reintervenciones.The rate and type of complications following Ender nailing in a series of 100 consecutive patients with trochanteric hip fractures were analysed. There were 75 women and 25 men with a mean age of 81 years. According to Jensen classification, 27% were stable fractures and 73% unstable. There were registered 32% of intraoperative complications and technical errors, 39% of distal migration of nails, 3% of proximal migrations with perforations of the femoral head and 11% of healing malpositions in varus. The rale of reoperations was 21%

Técnica de Ender y tornillo-placa deslizante a compresión en el tratamiento de las fracturas trocantéreas

Se realizó un estudio comparativo de 195 fracturas troncantéreas del fémur tratadas quirúrgicamente de las que 112 lo fueron mediante enclavado endomedular de Ender y 83 mediante tornillo-placa deslizante a compresión (TPDC). No encontramos diferencias significativas de las pérdidas sanguíneas entre las dos técnicas. El TPDC presentó mejores resultados funcionales salvo en pacientes mayores de 80 años en que son similares ambas técnicas. El enclavado Ender presentó mayor número de complicaciones mecánicas y reintervenciones.A comparative study on 195 throchanttric hip fractures treated Esther by Ender's mailing (112 cases) and slidding screw-plate (83 cases) were performed. There were no statistically significant differences between the two techniques regarding blood loosening. The slidding screw-plate showed better functional results, except in cases over 80 years old where both techniques were found to be similar. Ender's nailing disclosed a higher number of mechanical and reoperations

Síndrome de Mazabraud: Presentación de un caso clínico y revisión de la literatura

El síndrome de Mazabraud se define como la asociación de una tumoración de partes blandas, el mixoma intramuscular, y un tumor óseo, la displasia fibrosa. Se realiza una revisión bibliográfica de los casos publicados en la literatura, desde que en 1957, Mazabraud acuñó esta asociación como síndrome. El caso clínico corresponde a un varón de 43 años de edad con antecedentes de nódulo frío tiroideo, pigmentación cutánea y lesiones óseas en pelvis y tercio proximal fémur derecho, que acudió a la consulta por presentar una tumoración de partes blandas a nivel del muslo derecho de unos meses de evolución. Tras realizar biopsia de la misma se diagnosticó de mixoma intramuscular. El paciente se intervino quirúrgicamente practicándose resección amplia de la lesión. Hasta la fecha el enfermo no ha presentado recidiva de la lesión de partes blandas, y la displasia ósea no ha sufrido transformación maligna.Mazabraud's síndrome is the association of a soft-tissue tumour, intramuscular myxonma and a bone tumour, fibrous dysplasia. We review the literature since Mazabraud, in 1957 described this syndrome. We report a 43 years male who consulted for a soft-time mass in the right thigh. He also had bone lesions in pelvis and right femur that were diagnosted of fibrous dysplasia. We made a biopsy of soft-tissue tumour and it was diagnosed of intramuscular myxom. The patient was operated and the mass was removed. Till now, there is no recurrence of the myxom and there is no malignant degeneration of the fibrous dysplasia

Evaluation of dimensionality reduction methods applied to numerical weather models for solar radiation forecasting

The interest in solar radiation prediction has increased greatly in recent times among the scientific community. In this context, Machine Learning techniques have shown their ability to learn accurate prediction models. The aim of this paper is to go one step further and automatically achieve interpretability during the learning process by performing dimensionality reduction on the input variables. To this end, three non standard multivariate feature selection approaches are applied, based on the adaptation of strong learning algorithms to the feature selection task, as well as a battery of classic dimensionality reduction models. The goal is to obtain robust sets of features that not only improve prediction accuracy but also provide more interpretable and consistent results. Real data from the Weather Research and Forecasting model, which produces a very large number of variables, is used as the input. As is to be expected, the results prove that dimensionality reduction in general is a useful tool for improving performance, as well as easing the interpretability of the results. In fact, the proposed non standard methods offer important accuracy improvements and one of them provides with an intuitive and reduced selection of features and mesoscale nodes (around 10% of the initial variables centered on three specific nodes).This work has been partially supported by the projects TIN2014-54583-C2-2-R, TEC2014-52289-R and TEC2016-81900-REDT of the Spanish Interministerial Commission of Science and Technology (MICYT), and by Comunidad Autónoma de Madrid, under project PRICAM P2013ICE-2933

NOD1 deficiency promotes an imbalance of thyroid hormones and microbiota homeostasis in mice fed high fat diet

The contribution of the nucleotide-binding oligomerization domain protein NOD1 to obesity has been investigated in mice fed a high fat diet (HFD). Absence of NOD1 accelerates obesity as early as 2 weeks after feeding a HFD. The obesity was due to increases in abdominal and inguinal adipose tissues. Analysis of the resting energy expenditure showed an impaired function in NOD1-deficient animals, compatible with an alteration in thyroid hormone homeostasis. Interestingly, free thyroidal T4 increased in NOD1-deficient mice fed a HFD and the expression levels of UCP1 in brown adipose tissue were significantly lower in NOD1-deficient mice than in the wild type animals eating a HFD, thus contributing to the observed adiposity in NOD1-deficient mice. Feeding a HFD resulted in an alteration of the proinflammatory profile of these animals, with an increase in the infiltration of inflammatory cells in the liver and in the white adipose tissue, and an elevation of the circulating levels of TNF-α. In addition, alterations in the gut microbiota in NOD1-deficient mice correlate with increased vulnerability of their ecosystem to the HFD challenge and affect the immune-metabolic phenotype of obese mice. Together, the data are compatible with a protective function of NOD1 against low-grade inflammation and obesity under nutritional conditions enriched in saturated lipids. Moreover, one of the key players of this early obesity onset is a dysregulation in the metabolism and release of thyroid hormones leading to reduced energy expenditure, which represents a new role for these hormones in the metabolic actions controlled by NOD1.This work was supported by Grants SAF2017-82436R, AGL2017-88801-P and SAF2016-75004R from MINECO/AEI/FEDER/EU, S2017/BMD-3686 from Comunidad de Madrid, CIVP18A3864 from Fundación Ramón Areces and CIBERCV and CIBERHED (funded by the Instituto de Salud Carlos III) and Fondos FEDER.Peer reviewe

Key Learning Outcomes for Clinical Pharmacology and Therapeutics Education in Europe:A Modified Delphi Study

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired.</p

Revealing the reporting disparity: VigiBase highlights underreporting of clozapine in other Western European countries compared to the UK

Background: Pharmacovigilance studies indicate clozapine history is marked by adverse drug reactions (ADRs). Objective: In a 2021 article, the United Kingdom (UK) had >90 % of European clozapine-related fatal outcomes in VigiBase, the World Health Organization's pharmacovigilance database. Two possibly opposing hypotheses could explain this disparity: 1) fewer reported fatal outcomes in other Western European countries mainly reflect underreporting to VigiBase, and 2) the higher number of UK reports reflects higher real relative mortality. Methods: VigiBase reports from clozapine's introduction to December 31, 2022, were studied for ADRs and the top 10 causes of fatal outcomes. The UK was compared with 11 other top reporting Western countries (Germany, Denmark, France, Finland, Ireland, Italy, Netherlands, Norway, Spain, Sweden and Switzerland). Nine countries (except Ireland and Switzerland) were compared after controlling for population and clozapine prescriptions. Results: The UK accounted for 29 % of worldwide clozapine-related fatal outcomes, Germany 2 % and <1 % in each of the other countries. The nonspecific label "death" was the top cause in the world (46 %) and in the UK (33 %). "Pneumonia" was second in the world (8 %), the UK (12 %), Ireland (8 %) and Finland (14 %). Assuming that our corrections for population and clozapine use are correct, other countries underreported only 1-10 % of the UK clozapine fatal outcome number. Conclusions: Different Western European countries consistently underreport to VigiBase compared to the UK, but have different reporting/publishing styles for clozapine-related ADRs/fatal outcomes. Three Scandinavian registries suggest lives are saved as clozapine use increases, but this cannot be studied in pharmacovigilance databases