Revisión sistemática sobre la eficacia y seguridad de los neuroestimuladores periféricos del ganglio esfenopalatino para el tratamiento de la cefalea crónica en racimos refractaria

[EN] Introduction: This study aimed to assess the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion (SPG) in the treatment of refractory chronic cluster headache. Development: Various medical databases were used to perform a systematic review of the scientific literature. The search for articles continued until 31 October 2016, and included clinical trials, systematic reviews and/or meta-analyses, health technology assessment reports, and clinical practice guidelines that included measurements of efficiency/effectiveness or adverse effects associated with the treatment. The review excluded cohort studies, case–control studies, case series, literature reviews, letters to the editor, opinion pieces, editorials, and studies that had been duplicated or outdated by later publications from the same institution. Regarding effectiveness, we found that SPG stimulation had positive results for pain relief, attack frequency, medication use, and patients’ quality of life. In the results regarding safety, we found a significant number of adverse events in the first 30 days following the intervention. Removal of the device was necessary in some patients. Little follow-up data, and no long-term data, is available. Conclusions: These results are promising, despite the limited evidence available. We consider it essential for research to continue into the safety and efficacy of SPG stimulation for patients with refractory chronic cluster headache. In cases where this intervention may be indicated, treatment should be closely monitored. [ES] Introducción: El objetivo es evaluar la eficacia y seguridad de los neuroestimuladores periféricos del ganglio esfenopalatino (GEP) para el tratamiento de la cefalea en racimos crónica refractaria al tratamiento. Desarrollo: Revisión sistemática de la literatura científica. Se identificaron estudios mediante una búsqueda en diferentes bases de datos. Las estrategias de búsqueda se realizaron hasta el 31 de octubre de 2016, incluyendo ensayos clínicos, revisiones sistemáticas o metaanálisis, informes de evaluación de tecnologías sanitarias y guías de práctica clínica que recogieran medidas de eficacia/efectividad o efectos adversos asociados al tratamiento. Se excluyeron estudios de cohortes, casos y controles, series de casos, revisiones narrativas, cartas al director, artículos de opinión, editoriales y estudios duplicados o desfasados por estudios posteriores de la misma institución. Respecto a la eficacia, los resultados son positivos tras la estimulación del GEP en relación con el alivio de dolor, el número de episodios, el uso de la medicación o la calidad de vida del paciente. En relación con la seguridad, hay un número importante de efectos adversos en los primeros 30 días de la intervención y en algunos pacientes fue necesaria la retirada del dispositivo. Los datos de seguimiento son a corto plazo y escasos. Conclusiones: Los resultados resultan prometedores a pesar de que la evidencia disponible es limitada. Consideramos fundamental continuar con la investigación sobre la seguridad y eficacia de los neuroestimuladores del GEP en la cefalea en racimos crónica. En aquellos casos en que pueda estar indicada la intervención, el tratamiento debería realizarse supervisado en un estudio de monitorización.S

Sources of experimental errors in the observation of nanoscale magnetism

It has been recently reported that some non-magnetic materials in bulk state, exhibit magnetic behavior at the nanscale due to surface and size effects. The experimental observation of these effects is based on the measurement of very small magnetic signals. Thus, some spurious effects that are not critical for bulk materials with large magnetic signals may become important when measuring small signals (typically below 0.0001 emu). Here, we summarize some sources of these small magnetic signals that should be considered when studying this new nanomagnetismComment: 16 pages, 10 figure

Repeated magmatic intrusions at El Hierro Island following the 2011–2012 submarine eruption

After more than 200 years of quiescence, in July 2011 an intense seismic swarm was detected beneath the center of El Hierro Island (Canary Islands), culminating on 10 October 2011 in a submarine eruption, 2 km off the southern coast. Although the eruption officially ended on 5 March 2012, magmatic activity continued in the area. From June 2012 to March 2014, six earthquake swarms, indicative of magmatic intrusions, were detected underneath the island. We have studied these post-eruption intrusive events using GPS and InSAR techniques to characterize the ground surface deformation produced by each of these intrusions, and to determine the optimal source parameters (geometry, location, depth, volume change). Source inversions provide insight into the depth of the intrusions (~ 11–16 km) and the volume change associated with each of them (between 0.02 and 0.13 km3). During this period, > 20 cm of uplift was detected in the central-western part of the island, corresponding to approximately 0.32–0.38 km3 of magma intruded beneath the volcano. We suggest that these intrusions result from deep magma migrating from the mantle, trapped at the mantle/lower crust discontinuity in the form of sill-like bodies. This study, using joint inversion of GPS and InSAR data in a post-eruption period, provides important insight into the characteristics of the magmatic plumbing system of El Hierro, an oceanic intraplate volcanic island

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

¿Ha cambiado la actividad asistencial de la neurología pediátrica en 11 años?

Resumen: Introducción: Pensamos que en la última década ha existido un aumento en la demanda de atención de neurología pediátrica (NP) por parte de la población pero también con un cambio cualitativo en las patologías que se atienden.Por este motivo planteamos realizar un segundo registro (2013) y analizar si existían o no diferencias con el efectuado en el año 2002. Métodos: Se realiza un registro prospectivo de actividad asistencia de NP en el Hospital Universitario de Getafe en 2013 y se compara con otro registro prospectivo previo realizado en 2002. Resultados: Se ha pasado de 1.300 consultas a 1.982 (incremento del 52,46%) y de 32,6 consultas/1.000 niños al año a 57,48 (76,32% de aumento).La actividad en consulta supone el 92,2% de toda la asistencia neuropediátrica del 2013; actualmente el trastorno por déficit de atención e hiperactividad (TDAH) es la patología más frecuente (27,6% en 2013/8,1% en 2002). Aunque las cefaleas siguen siendo muy frecuentes han disminuido (19% en 2013/22% en 2002). Como primeras consultas la cefalea sigue siendo la más frecuente en 2013 (32,1%), seguida del TDAH (19,1%). En régimen de hospitalización la epilepsia continúa siendo el diagnóstico más frecuente (30,3% en 2013/36,7% en 2002). Conclusiones: La NP continúa siendo una actividad básicamente ambulatoria, con un incremento considerable en los últimos años. Este aumento se debe fundamentalmente a los trastornos del neurodesarrollo y muy especialmente al TDAH. Podríamos decir que el TDAH es a la NP lo que la demencia a la neurología general. Abstract: Introduction: We believe that the demand for paediatric neurology (PN) care has increased over the past decade, and that reasons for requesting consultations have also changed. The objective of this study is to complete a registry study to profile the demand for PN care in 2013 and compare results to those from a study performed in 2002. Methods: A prospective registry of PN healthcare activities was completed at Hospital Universitario de Getafe in 2013. Results were compared with those from a prospective registry study conducted in 2002. Results: The number of visits increased from 1,300 in 2002 to 1,982 in 2013 (a 52.46% increase), and from 32.6 visits per 1,000 children to 57.48 (a 76.32% increase). Outpatient consultations accounted for 92.2% of all PN consultations in 2013. Currently, attention deficit-hyperactivity disorder (ADHD) is the most frequent diagnosis (27.6% in 2013 vs. 8.1% in 2002). Although the percentage of headache consultations has decreased (19% in 2013 vs. 22% in 2002), headache was still the most common reason for an initial visit in 2013 (32.1%), followed by ADHD (19.1%). Epilepsy remains the most frequent diagnosis in hospitalised patients (30.3% in 2013 vs. 36.7% in 2002). Conclusions: PN is fundamentally an outpatient activity that has increased considerably in recent years. This increase is mainly due to neurodevelopmental disorders, especially ADHD. We might state that the role of ADHD in PN is comparable to that of dementia in general neurology. Palabras clave: Actividad asistencial, Gestión sanitaria, Neurología infantil, Neurología pediátrica, Neurodesarrollo, TDAH, Keywords: Medical care, Healthcare administration, Child neurology, Paediatric neurology, Neurodevelopment, ADH