A pending challenge for the primary nursing: the early detection of feeding and eating disorders

RESUMEN: Los trastornos de la conducta alimentaria (TCA) son patologías mentales crecientes con un continuo aumento de incidencia y prevalencia en un amplio número de grupos poblacionales. La falta de conciencia de la enfermedad, el retraso en la demanda asistencial, la dificultad diagnóstica y las repercusiones asociadas, a nivel individual, social, familiar y sanitario, hace necesario la implicación de los profesionales sanitarios en una intervención precoz. Se ha demostrado que el ámbito de atención primaria (AP) juega un papel muy importante en el abordaje y detección precoz de estos trastornos. Por ello, el equipo multidisciplinar de AP, en especial el profesional de enfermería, debe afrontar las dificultades y dar un paso al frente. Resulta fundamental conocer y estar entrenado en las estrategias de actuación que se llevan a cabo en los programas dirigidos a la prevención primaria y secundaria, con el objetivo de reducir el número de nuevos casos anuales, así como, la magnitud de las complicaciones, las tasas de cronicidad y morbilidad, y el mal pronóstico de los usuarios con esta enfermedad.ABSTRACT: Feeding and eating disorders are growing mental pathologies with a continuous increase in incidence and prevalence in a large number of population groups. The lack of awareness of the disease, the delay in the demand for care, the diagnostic difficulty and the associated repercussions, at the individual, social, family and health levels, make it necessary to involve health professionals in an early intervention. It has been shown that the field of primary care has a very important role in the approach and early detection of these disorders. Therefore, the multidisciplinary team of Primary Care, especially the nursing professional, must face the difficulties and take a step forward. It is essential to know and be trained in the action strategies that are carried out in the programs aimed at primary and secondary prevention, with the aim of reducing the number of new cases per year, as well as, the magnitude of the complications, the rates of chronicity and morbidity, and the poor prognosis of users with this disease.Grado en Enfermerí

Insuficiencia cardíaca con función sistólica preservada de etiología infiltrativa. El enemigo silencioso

Heart failure with preserved ejection fraction still remains being one of the paradigms of modern Cardiology. Reaching the correct diagnosis and identifying the etiology is a diffi cult challenge, where the new techniques of strain rate may develop an important role. In therms of medical therapies, there is a lack of specific measures in order to improve the prognosis of these patients. Our clinical report tries to show the clinical situation and echocardiographic patterns that must establish the suspicion of cardiac amyloidosis.La insuficiencia cardíaca con función sistólica preservada continúa siendo uno de los grandes cuadros clínicos de la cardiología actual, tanto desde el punto de vista del diagnóstico, donde identificar la etiología concreta resulta un reto frente al que las novedosas técnicas de strain rate comienzan a aportar luz, como del tratamiento, dada la ausencia de medidas específicas que mejoren el pronóstico de estos pacientes. Este caso clínico trata de mostrar la situación clínica y los patrones ecocardiográficos que deben establecer la sospecha de amiloidosis cardíaca

Load-invariant double class-E/F2 resonant topology for UHF DC-DC power conversion

This work addresses the design of a double class-E/F2 resonant power converter operating under a varying dc load at UHF band. Based on a RF GaN HEMT, the performance of a class-E/F2 power amplifier (PA) is compared through simulations with the one from a class-E PA using the same transistor. The efficiency enhancement potential offered by a second harmonic termination typical of class-F-1 PAs, associated to a reduction of the transistor conduction losses, is however degraded by the losses in the passive elements due to the need for a more complex network interconnecting the inverting and rectifying parts of the converter. Measured efficiency results include a peak value of 75% and a profile above 60% for dc output power levels up to a 35% of the peak or nominal value (13.4 W)

Imagen multimodal en la endocarditis infecciosa: el dilema del huevo o la gallina

In medicine the clinical context is essential to carry out a differential diagnosis, and thus it is important for the interpretation of the findings in the imaging techniques to be aware of the clinical history of the patient we are evaluating. We present a case of a patient derived to our hospital for the suspicious of endocarditis on the native mitral valve. However, in our hospital we found no compatible images with endocarditis, but a dissection in the ascending aorta with no signs of infection. Due to the chronology of the clinical case we concluded that the most likely diagnosis was a pseudoaneurysm secondary of an endocarditis.En medicina el contexto clínico es esencial para llevar a cabo un diagnóstico diferencial, y por este motivo es importante que los hallazgos de las pruebas de imagen vayan acompañados de la historia clínica del paciente para poderse interpretar. A continuación, se presenta el caso de una sospecha de endocarditis sobre válvula mitral que se remitió a nuestro centro; sin embargo, el equipo no encontró signos compatibles con endocarditis, más bien una disección en la aorta ascendente. Debido a la cronología de la historia clínica se concluyó que el diagnóstico más plausible era un pseudoaneurisma secundario a endocarditis

Patología pericárdica. Reto diagnóstico y terapéutico en la era de la imagen cardíaca multimodal a propósito de un caso

The pericardium consists of two layers, the visceral pericardium consisting of a single layer of mesothelial cells, elastin and collagen, attached to the epicardial surface of the heart, and an avascular parietal layer with an extensive network of collagen fibers. In humans, this fine structure normally reaches up to 2 mm thick. Its function is basically mechanical adapting to the volume changes of the cardiac cavities, although important variations of these or affectation of its tissue, makes it more rigid conditioning a restrictive behavior. There are many pathologies that can affect it, from inflammation, trauma, radiation to tumor infiltration.El pericardio está formado por dos capas: el pericardio visceral, constituido por una sola capa de células mesoteliales, elastina y colágeno, adherido a la superficie epicárdica del corazón, y una capa parietal avascular y con amplia red de fibras de colágeno. En el ser humano esta fina estructura llega a medir normalmente hasta 2 mm de espesor. Su función es fundamentalmente mecánica adaptándose a los cambios de volumen de las cavidades cardíacas, aunque variaciones importantes de éstas o la afectación de su tejido, lo hace más rígido condicionando un comportamiento constrictivo. Son múltiples las patologías que pueden afectarlo, desde inflamación, trauma, radiación hasta infiltración tumoral

Distortion of the QRS in elderly patients with myocardial infarction

Background: Distortion of the terminal portion of the QRS in the initial electrocardiogram (ECG) is a strong predictor of adverse outcome in myocardial infarction. Our purpose is to assess the relationship of distortion of QRS and other ECG characteristics with older age. Methods and results: We analysed 634 consecutive patients (age 62.6 &#177; 13.7, 77% male) admitted in the first 12 hours of ST-elevation myocardial infarction. Two groups of age were defined: < 75 years-old and &#8805; 75 years-old. Additionally, we defined two ECG groups according to the presence of ST segment elevation with distortion of the terminal portion of the QRS in two or more adjacent leads (QRS+) or the absence of this pattern (QRS&#8211;). Older people had more often QRS+ (30% vs. 20%, p = 0.023). The older group with QRS+ had an in-hospital mortality of 18%, vs. 7% with QRS&#8211; (p = 0.04), and an incidence of major adverse events of 40% vs. 14% (p = 0.002). In the multivariate analysis, age &#8805; 75 years was an independent predictor of distortion of the QRS (odds ratio 2.1, 1.2&#8211;4.9, p = 0.016). Conclusions: The distortion of the terminal portion of the QRS in myocardial infarction is more frequent in elderly people, and is significantly related to adverse prognosis. This ECG finding can be helpful to promptly stratify the risk in elderly patient

¿Viable o no viable? El problema del manejo de la enfermedad coronaria muy avanzada

Patients with very advanced coronary disease are a hard challenge for the clinician. This clinical report is a good example, with a patient with very extensive and severe arteriosclerosis in several vascular territories that debuted as acute leg arterial ischemia but in which the coronary disease became the worst problem. Despite myocardial viability demonstration, the extent and complexity of coronary lesions made it impossible treat them. In this kind of cases, although we know what the ideal treatment should be, the trip ends without reaching the goal of the revascularization.Los pacientes con enfermedad coronaria muy avanzada son todo un reto para el clínico. Este caso clínico es un buen ejemplo de ello, con un paciente con arterioesclerosis muy extensa y grave en varios territorios vasculares que debuta con isquemia arterial aguda, pero en el que la evolución predomina la disfunción ventricular por enfermedad coronaria. A pesar de demostrar viabilidad miocárdica en las pruebas de imagen, la extensión y complejidad de las lesiones hizo que no fuera posible tratarlas. En casos como éste, a pesar de que se conoce cuál es el tratamiento ideal, el viaje termina sin alcanzar la orilla de la revascularización