Predictores de Intubación Difícil en la consulta perioperatoria de Otorrinolaringología. Revisión 2015

Resulta fundamental la identificación con suficiente antelación de pacientes con probable Vía Aérea Difícil (VAD) para asegurar un manejo adecuado de tipo multidisciplinar. Para ello, deberemos realizar una exhaustiva historia clínica y anamnesis. Se asocian con mayor dificultad en la intubación orotraqueal (IOT) la historia previa de dificultad de IOT, radiación de cabeza y cuello, malformaciones congénitas, alteraciones espinales a nivel cervical, obesidad y el Síndrome de Apneas-Hipopneas del Sueño (SAHS). En la exploración física, parámetros como la disminución de la apertura bucal y/o extensión cervical, test de Mallampati y el aumento de la circunferencia del cuello están relacionados con dificultad en la IOT. Es imprescindible elaborar un plan de actuación, con una estrecha colaboración interdisciplinar. La incidencia de dificultad en la IOT se encuentra entre el 1% y el 5.8%, con una importante morbimortalidad. La mayoría de los errores en el manejo de la vía aérea son debidos al desconocimiento y falta de preparación del personal sanitario. Por ello, hay que reconocer los pacientes con posible VAD para elaborar una estrategia, que incluya a los staff de diferentes especialidades como Anestesiología y Otorrinolaringología, así como Enfermería. Como herramientas, contamos con la historia clínica y la exploración física, que permiten detectar predictores de una VAD, que aunque no ofrezcan a nivel individual una sensibilidad ni especificidad del 100%, combinadas, facilitan la anticipación para un abordaje óptimo

Akilesen tendinopatiari zuzendutako tratamendu fisioterapeutikoa.

[EUS] Sarrera: Akiles tendoia edo tendoi kalkaneoa gorputzean aurkitzen den tendoirik luze eta indartsuena bada ere, maiz lesionatzen da. Kasuen %55-65a tendinopatiak izaten dira, eta populazio kirolari eta sedentarioari eragiten die. Tendinopatia tendoiaren kondizio mingarriari deritzo, normalean iraupen luzekoa. Lehen lerroko tratamendu bezala teknika kontserbadoreak erabiltzen dira, baina kasuen %24-45tan 6 hilabetetara huts egin eta kirurgia burutzen zaie. Helburuak: Akilesen tendinopatia tratatzeko aukera desberdinen ebidentzia arakatu eta teknika kontserbadoreen eraginkortasuna aztertzea nahi izan da, bai isolatua eta baita modu konbinatuan ere. Metodoak: Pubmed, Science Direct eta PEDro datu baseetan 2000. urtetik aurrerako Akilesen tendinopatiaren talka uhin eta ariketa eszentrikoen tratamendu bilaketa egin da. Laginaren barnean tendoiaren erdialdeko tendinopatiadun pazienteak bildu ziren kasu guztietan. Talka uhinen tratamendua 3-5 sesio artekoa izatea hartu zen kontutan eta ariketa eszentrikoetan Alfredson protokoloaren aplikazioa egitea. Lehen mailako aldagaitzat mina eta bigarren mailakotzat funtzionalitatea eta asebetetzea kontsideratu dira. Emaitzak: Hamaika artikulu barneratu dira, 5 tratamendu aukera bakoitzetik eta azkena bi tekniken konbinazioan oinarrituta. Ikerketa bakarrean konparaketa taldeak emaitza hobeak lortu zituen ariketa eszentrikoekin alderatuta. Ikerketa guztietan minaren aldagaiaren hobekuntza jaso zen, aldiz funtzionalitatea aztertu zen 2 kasutan ez zen aldaketarik erregistratu. Asebetetzea gutxien ikertu den aldagaia izan da. Ondorioak: Bi tratamenduak modu isolatuan eraginkorrak dira, baina bien konbinazioarekin aldagai guztietan hobekuntza adierazgarriak lortu dira. Berrikusketa honen bidez Akilesen tendinopatiaren tratamendurako ariketa aktiboen garrantzia ikusi da. Etorkizunera begira, tendoiaren erdialdeko tendinopatien maneiurako bi tekniken bateratzean oinarritutako ikerketa gehiago beharko dira ondorio garbiak atera ahal izateko. Hitz gakoak: Achilles; tendinopathy; tendinitis; tendinosis; shock wave therapy; eccentric; exercise; training; protocol; strengthening. Euskar

Estudio del tejido empresarial de Donostia-San Sebastián, en colaboración con Fomento de San Sebastián

La crisis económica en la que estamos sumergidos desde 2008 ha generado el cierre de un gran número de empresas. Esta cuestión ha afectado al tejido empresarial de las distintas comarcas y ciudades de la Comunidad Autónoma del País Vasco. Por lo tanto, existe la necesidad de profundizar en el análisis de esta realidad, aportando por ejemplo, estudios basados en el análisis económico-financiero de las empresas. Este Trabajo de Fin de Grado tiene como objetivo realizar una pequeña aportación al respecto, examinando la evolución económica-financiera del tejido empresarial de San Sebastián. Para ello, se han calculado e interpretado ocho indicadores económico-financieros a partir de los datos de una muestra de casi 5.000 empresas donostiarras

Akilesen tendinopatiari zuzendutako tratamendu fisioterapeutikoa.

[EUS] Sarrera: Akiles tendoia edo tendoi kalkaneoa gorputzean aurkitzen den tendoirik luze eta indartsuena bada ere, maiz lesionatzen da. Kasuen %55-65a tendinopatiak izaten dira, eta populazio kirolari eta sedentarioari eragiten die. Tendinopatia tendoiaren kondizio mingarriari deritzo, normalean iraupen luzekoa. Lehen lerroko tratamendu bezala teknika kontserbadoreak erabiltzen dira, baina kasuen %24-45tan 6 hilabetetara huts egin eta kirurgia burutzen zaie. Helburuak: Akilesen tendinopatia tratatzeko aukera desberdinen ebidentzia arakatu eta teknika kontserbadoreen eraginkortasuna aztertzea nahi izan da, bai isolatua eta baita modu konbinatuan ere. Metodoak: Pubmed, Science Direct eta PEDro datu baseetan 2000. urtetik aurrerako Akilesen tendinopatiaren talka uhin eta ariketa eszentrikoen tratamendu bilaketa egin da. Laginaren barnean tendoiaren erdialdeko tendinopatiadun pazienteak bildu ziren kasu guztietan. Talka uhinen tratamendua 3-5 sesio artekoa izatea hartu zen kontutan eta ariketa eszentrikoetan Alfredson protokoloaren aplikazioa egitea. Lehen mailako aldagaitzat mina eta bigarren mailakotzat funtzionalitatea eta asebetetzea kontsideratu dira. Emaitzak: Hamaika artikulu barneratu dira, 5 tratamendu aukera bakoitzetik eta azkena bi tekniken konbinazioan oinarrituta. Ikerketa bakarrean konparaketa taldeak emaitza hobeak lortu zituen ariketa eszentrikoekin alderatuta. Ikerketa guztietan minaren aldagaiaren hobekuntza jaso zen, aldiz funtzionalitatea aztertu zen 2 kasutan ez zen aldaketarik erregistratu. Asebetetzea gutxien ikertu den aldagaia izan da. Ondorioak: Bi tratamenduak modu isolatuan eraginkorrak dira, baina bien konbinazioarekin aldagai guztietan hobekuntza adierazgarriak lortu dira. Berrikusketa honen bidez Akilesen tendinopatiaren tratamendurako ariketa aktiboen garrantzia ikusi da. Etorkizunera begira, tendoiaren erdialdeko tendinopatien maneiurako bi tekniken bateratzean oinarritutako ikerketa gehiago beharko dira ondorio garbiak atera ahal izateko. Hitz gakoak: Achilles; tendinopathy; tendinitis; tendinosis; shock wave therapy; eccentric; exercise; training; protocol; strengthening. Euskar

Estevia, el edulcorante natural.

La estevia, Stevia rebaudiana (Bertoni) Bertoni, es una planta herbácea y perenne descrita por primera vez en 1889 por el naturalista Moisés Bertoni. Se trata de una especie originaria de la Región Oriental de Paraguay, donde los indígenas guaraníes la han usado tradicionalmente por sus aplicaciones edulcorantes y medicinales. La hoja fresca de estevia es de 10 a 15 veces más dulce que el azúcar común, la hoja seca y pulverizada lo es unas 70, mientras que los extractos lo son hasta 200 ó 300 veces más, debido a los glucósidos: esteviósido, rebaudósido A, B, C, D, E, dulcósido A y B y steviolbiósido. Entre las propiedades medicinales destacan las acciones hipotensora, antimicrobiana, dietética, digestiva e hipoglucémica, por lo que su uso está muy recomendado para personas afectadas de diabetes tipo 2. El cultivo de estevia ha adquirido importancia en algunos países como China, Paraguay o Brasil. Entre los principales consumidores se encuentran Japón, China, Malasia, Israel, Corea del Sur y Brasil. Sin embargo, en los países de la Unión Europea, por el momento, está denegado su uso como aditivo alimenticio o suplemento dietétic

Polinizadores y polinización en frutales subtropicales : implicaciones en manejo, conservación y seguridad alimentaria

The commercialization and consumption of tropical fruits has grown worldwide during the last decade. This trend is expected to continue, due to the increasing world population and the greater demand for these products in western markets. As in most fruit crops, one of the main bottlenecks in production is pollination, which determines fruit-tree and pollinator management to a large extent. Pollination management is therefore a defining factor in the composition and diversity of agro-systems. Because of this, the intensive production of fruit crops in many areas of the world requires adequate management of crops to enable: (1) an optimal production of fruit crops; (2) the conservation of insect communities. This is particularly important in developing countries, where the centers of genetic diversity of these crops are generally found and pollinator diversity is often poorly known and seriously threatened by agricultural intensification. However, some of these crops have been introduced into geographic areas away from the native areas of origin, which is an agronomic challenge but, at the same time, provides an opportunity to study and test under controlled conditions new management strategies. In this work we present a brief review on pollinators and pollination in subtropical fruit crops focusing on three species of international economic relevance such as mango, avocado and cherimoya. With the knowledge acquired on these species in a Mediterranean context, we propose a road-map to develop appropriate management strategies in other fruit crops and geographical areas

Temporal evolution of brain cancer incidence in the municipalities of Navarre and the Basque Country, Spain

Background: Brain cancer incidence rates in Spain are below the European’s average. However, there are two regions in the north of the country, Navarre and the Basque Country, ranked among the European regions with the highest incidence rates for both males and females. Our objective here was two-fold. Firstly, to describe the temporal evolution of the geographical pattern of brain cancer incidence in Navarre and the Basque Country, and secondly, to look for specific high risk areas (municipalities) within these two regions in the study period (1986–2008). Methods: A mixed Poisson model with two levels of spatial effects is used. The model also included two levels of spatial effects (municipalities and local health areas). Model fitting was carried out using penalized quasi-likelihood. High risk regions were detected using upper one-sided confidence intervals. Results: Results revealed a group of high risk areas surrounding Pamplona, the capital city of Navarre, and a few municipalities with significant high risks in the northern part of the region, specifically in the border between Navarre and the Basque Country (Gipuzkoa). The global temporal trend was found to be increasing. Differences were also observed among specific risk evolutions in certain municipalities. Conclusions: Brain cancer incidence in Navarre and the Basque Country (Spain) is still increasing with time. The number of high risk areas within those two regions is also increasing. Our study highlights the need of continuous surveillance of this cancer in the areas of high risk. However, due to the low percentage of cases explained by the known risk factors, primary prevention should be applied as a general recommendation in these populations.This research has been supported by the Spanish Ministry of Science and Innovation (project MTM 2011-22664, jointly sponsored with FEDER grants and project MTM2014-51992-R), and by the Health Department of the Navarre Government (project 113, Res.2186/2014)

Consumption of fried foods and risk of coronary heart disease: Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study

Objective To assess the association between consumption of fried foods and risk of coronary heart disease

The role of plasma microseminoprotein-beta in prostate cancer: an observational nested case–control and Mendelian randomization study in the European prospective investigation into cancer and nutrition

Background: Microseminoprotein-beta (MSP), a protein secreted by the prostate epithelium, may have a protective role in the development of prostate cancer. The only previous prospective study found a 2% reduced prostate cancer risk per unit increase in MSP. This work investigates the association of MSP with prostate cancer risk using observational and Mendelian randomization (MR) methods. Patients and methods: A nested case-control study was conducted with the European Prospective Investigation into Cancer and Nutrition (EPIC) with 1871 cases and 1871 matched controls. Conditional logistic regression analysis was used to investigate the association of pre-diagnostic circulating MSP with risk of incident prostate cancer overall and by tumour subtype. EPIC-derived estimates were combined with published data to calculate an MR estimate using two-sample inverse-variance method. Results: Plasma MSP concentrations were inversely associated with prostate cancer risk after adjusting for total prostate-specific antigen concentration [odds ratio (OR) highest versus lowest fourth of MSP = 0.65, 95% confidence interval (CI) 0.51-0.84, Ptrend = 0.001]. No heterogeneity in this association was observed by tumour stage or histological grade. Plasma MSP concentrations were 66% lower in rs10993994 TT compared with CC homozygotes (per allele difference in MSP: 6.09 ng/ml, 95% CI 5.56-6.61, r2=0.42). MR analyses supported a potentially causal protective association of MSP with prostate cancer risk (OR per 1 ng/ml increase in MSP for MR: 0.96, 95% CI 0.95-0.97 versus EPIC observational: 0.98, 95% CI 0.97-0.99). Limitations include lack of complete tumour subtype information and more complete information on the biological function of MSP. Conclusions: In this large prospective European study and using MR analyses, men with high circulating MSP concentration have a lower risk of prostate cancer. MSP may play a causally protective role in prostate cancer

Recent Changes in Breast Cancer Incidence in Spain, 1980–2004

BACKGROUND: Since the 1980s, Spain experienced two decades of sharply increasing breast cancer incidence. Declines in breast cancer incidence have recently been reported in many developed countries. We examined whether a similar downturn might have taken place in Spain in recent years. METHODS: Cases of invasive female breast cancer were drawn from all population-based Spanish cancer registries that had at least 10 years of uninterrupted registration over the period 1980-2004. Overall and age-specific changes in incidence rates were evaluated using change-point Poisson models, which allow for accurate detection and estimation of trend changes. All statistical tests were two-sided. RESULTS: A total of 80,453 incident cases of invasive breast cancer were identified. Overall age- and registry-adjusted incidence rates rose by 2.9% (95% confidence interval [CI] = 2.7% to 3.1%) annually during the 1980s and 1990s; there was a statistically significant change in this trend in 2001 (95% CI = 1998 to 2004; P value for the existence of a change point <.001), after which incidence declined annually by 3.0% (95% CI = 1.8% to 4.1%). This trend differed by age group: There was a steady increase in incidence for women younger than 45 years, an abrupt downturn in 2001 for women aged 45-64 years, and a gradual leveling off in 1995 for women aged 65 years or older. Separate analyses for registries that had at least 15 years of uninterrupted registration detected a statistically significant interruption of the previous upward trend in breast cancer incidence in provinces that had aggressive breast cancer screening programs and high screening participation rates, including Navarra (change point = 1991, P < .001), Granada (change point = 2002, P = .003), Bizkaia (change point = 1998, P < .001), Gipuzkoa (change point = 1998, P = .001), and Araba (change point = 1997, P = .002). CONCLUSIONS: The recent downturn in breast cancer incidence among Spanish women older than 45 years is best explained by a period effect linked to screening saturation.Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) (AC07-005 to M.P., PM07-004 to R.P-B.) and Carlos III Institute of Health (ISCIII-CIBERESP collaborative agreement “Acción Transversal del Cancer”).S