Prevalencia del dolor en pacientes hospitalizados en el Servicio de Neurocirugía de un Hospital Universitario Terciario en Madrid, España

Objectives: to measure the prevalence and intensity of acute pain in hospitalized patients in the Neurosurgery Service of a Tertiary Hospital, using a numerical verbal scale, the Visual Analogue Scale (VAS) for its evaluation. Material and methods: observational, cross-sectional study to evaluate acute pain. All patients admitted to the ward during November 2019 are included and those with limitations to understand or evaluate pain according to VAS are excluded. Results: of the total of 120 patients admitted to the ward during the study period, 40 were excluded because they did not meet the inclusion criteria. Eighty patients with a high prevalence of pain (76.61%) were analyzed, with a mean score of 3.47 ± 0.78. Of those who report pain, 20% is mild, 40% moderate and 40% intense. For pathologies, the highest values ​​correspond to post-intervention. Hospital analgesic protocols were applied in all cases and no patient went to the emergency room due to pain after hospital discharge. The main limitation of the study was that the VAS score was not adequately collected in all patients. Conclusions: the prevalence of pain in a neurosurgery ward is high (76.61%), with average scores (3-4, moderate pain) that require improving our analgesic strategies and its measurement. Malignant diseases, predominantly intracranial, were associated with greater pain.Objetivos: medir la prevalencia e intensidad del dolor agudo en pacientes hospitalizados en el Servicio de Neurocirugía de un Hospital Terciario, utilizando una escala verbal numérica, la Escala Visual Analógica (EVA) para su evaluación. Material y métodos: estudio observacional, transversal, para evaluar el dolor agudo. Se incluyen todos los pacientes ingresados en planta durante noviembre del 2019 y se excluyen aquellos con limitaciones para entender o evaluar el dolor según EVA. Resultados: del total de 120 pacientes ingresados en planta durante el periodo de estudio, son excluidos 40 por no cumplir los criterios de inclusión. Se analizan 80 pacientes que presentan elevada prevalencia de dolor (76,61%), con una puntuación media de 3,47 ± 0.78. De los que refieren dolor, en un 20% es leve, 40% moderado y 40% intenso. Por patologías los valores más elevados corresponden a post-intervención. Los protocolos analgésicos del Hospital se aplicaron en todos los casos y ningún paciente acudió a urgencias por dolor tras el alta hospitalaria. La principal limitación del estudio fue que no en todos los pacientes se recogió adecuadamente la puntuación EVA. Conclusiones: la prevalencia de dolor en una planta de neurocirugía es elevada (76,61%), con unas puntuaciones medias (3-4, dolor moderado) que requieren mejorar nuestras estrategias analgésicas y la medición del mismo. Las enfermedades malignas, de predominio intracraneal, se asociaron con mayor dolor

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Mild head injury

Introducción y objetivo: El TCE leve representa un problema sanitario de enorme interés debido a que un número significativo de enfermos con trauma leve desarrollará complicaciones potencialmente mortales. El objetivo de este estudio ha sido describir una serie amplia de pacientes adultos, mayores de 14 años, que sufren TCE leve, atendidos en el Hospital Universitario de Getafe, entre los años 2010 y 2015 (n = 2480), estudiar el perfil epidemiológico y analizar el diagnóstico y el tratamiento efectuados, así como establecer los principales factores pronósticos que influyen en el resultado final. Go to: Método: Se ha realizado un estudio retrospectivo, de revisión de historias clínicas, analizando los resultados con estudio estadístico bivariable y multivariable. Go to: Resultados: El TCE leve es más frecuente en varones, y el mecanismo causante más común en nuestro medio es el accidente de tráfico. Se propone un modelo de clasificación de pacientes según grupos de riesgo, que los subdivide en riesgo bajo, intermedio o alto, que se correlaciona bien con la probabilidad de desarrollar complicación intracraneal, y, consecuentemente, con el resultado final. Se discute la indicación de la radiografía simple de cráneo y de la Tomografía Computarizada (TC), así como del ingreso hospitalario para observación neurológica. Go to: Conclusiones: En este estudio, la presencia de focalidad neurológica en la exploración clínica, la edad, las alteraciones de la coagulación y la existencia de fractura en la radiografía simple se relacionan con mayor posibilidad de desarrollar lesiones traumáticas intracraneales y con peor pronóstico final. La escala de Glasgow para el Coma es deficitaria en la determinación del resultado final del paciente que sufre TCE, porque no considera variables tales como la amnesia o la pérdida de conocimiento, muy frecuentes en el traumatismo craneoencefálico leve.Introduction: Mild traumatic brain injury (TBI) represents a major health concern, because a sizeable number of patients with mild TBI will develop potentially life-threatening complications. The target of this study was to describe a large series of adult patients suffering from mild TBI, treated at University Hospital of Getafe, between 2010 and 2015 (n = 2480). We examined the patients’ epidemiological and baseline clinical profile, diagnosis, treatment and ultimate outcomes, to identify major prognostic factors that influence the final result. Methods: We retrospectively extracted patient data from medical records and performed both bivariate and multivariate statistics. Results: In our sample, mild TBI was more common in men, and the most common causative mechanism was a traffic accident. We proposed a model for classifying patients according to risk, dividing them into low, intermediate and high risk, based upon their baseline clinical picture. This classification scheme correlated well with final outcomes. We investigated indications for skull radiography and computed tomography (CT), as well as for hospital admission for clinical observation. Conclusions: In this study, the presence of a neurological focus on clinical examination, the existence of a fracture on plain radiographs, advanced age and the presence of a coagulation disorder were associated with the increased likelihood of intracranial complications and a poor prognosis. The Glasgow Coma Scale was deficient predicting patient outcomes, because it failed to account for concussion-related symptoms like amnesia and loss of consciousness, both very common in patients with mild TBI.Sin financiaciónNo data JCR (2018)0.405 SJR (2018) Q3, 235/378 Neurology (clinical), 230/448 SurgeryNo data IDR 2018UE

Aneurismal subarachnoid hemorraghe: Clinical advances

Se estudió a un total de 343 pacientes (pinzamientos quirúrgicos 185 y embolizaciones 158). Se estableció que la realización de tomografía computarizada (TC) de cráneo y arteriografía cerebral, así como el ingreso en la Unidad de Cuidados Intensivos, es el mejor manejo en este tipo de pacientes. Se ha demostrado que la embolización ha ido disminuyendo el número de complicaciones, siendo el tratamiento de elección a día de hoy. En este estudio, la situación clínica al ingreso, la cantidad de sangre hallada en la TC y la edad del paciente han resultado ser las variables más determinantes en el resultado final.We studied a total of 343 patients (185 surgery and 158 embolization). It has been established that Computed Tomography (CT) and cerebral arteriography, with ICU admission, is the best therapeutic approach in this type of patients. It has been shown that embolization, the treatment of choice today, has decreased the number of complications in these years. In this study, patient's clinical condition at admission, the amount of blood found in the CT and patient's age have proved the most decisive factors in the final outcome.Sin financiación0.104 SJR (2017) Q4, 343/359 Neurology (clinical), 151/154 NeurologyUE

Diagnosis and surgical treatment versus endovascular of subarachnoid aneurismatic hemorrhage

Introducción: Tras un episodio de hemorragia subaracnoidea inicial fallecen hasta el 50% de los pacientes, y el 30-40% de los enfermos sufren un nuevo sangrado durante el primer mes. El porcentaje de defunciones debido al resangrado se encuentra entre el 60 y el 75%. Tanto la embolización endovascular como la cirugía disminuyen la tasa de mortalidad y mejoran la calidad de vida de los supervivientes. Objetivo: El objetivo de este estudio ha sido describir una serie de pacientes con hemorragia subaracnoidea espontánea, secundaria a rotura aneurismática, tratados en el Hospital Universitario de Getafe entre los años 2010 y 2019, estudiar las diferentes opciones de diagnóstico y de tratamiento, y definir los factores pronósticos más importantes. Además, se compararon los resultados de ambos tratamientos (quirúrgico y endovascular). Material y métodos: Se ha llevado a cabo un estudio descriptivo, retrospectivo, de revisión de historias clínicas, recogiendo las principales variables epidemiológicas y clínicas. Resultados: Se ha estudiado a 110 pacientes, 58 varones y 52 mujeres, con una edad media de 40,8 años. Del total, 25 pacientes han sido tratados quirúrgicamente y 85 mediante embolización endovascular. En este estudio, la situación clínica neurológica al ingreso, el volumen y la distribución de sangre en la tomografía computarizada y la edad del paciente parecen ser las variables más influyentes en el resultado evolutivo final. Discusión: Se ha establecido que el mejor manejo en este tipo de pacientes es la realización de tomografía computarizada de cráneo y arteriografía cerebral, así como el ingreso para vigilancia en UCI. La cirugía sigue teniendo un papel importante en el tratamiento de los aneurismas que originan hemorragia subaracnoidea, y las indicaciones de la embolización endovascular están cada vez mejor definidas. La embolización endovascular es un método seguro y efectivo en el tratamiento de los aneurismas cerebrales.Introduction: After an episode of initial subarachnoid hemorrhage, up to 50% of patients die, and 30-40% of patients suffer from new bleeding during the first month. The percentage of deaths due to rebleeding is between 60% and 75%. Both endovascular embolization and surgery decrease the mortality rate, and improve the quality of life of survivors. Objective: The objective of this study has been to describe a series of patients with spontaneous subarachnoid hemorrhage, secondary to aneurysmal rupture, treated at the University Hospital of Getafe between 2010 and 2019, study the different diagnostic and treatment options, and define the most important prognostic factors. In addition, compare the results of both treatments (surgical and endovascular). Material and methods: A descriptive, retrospective study of review of medical records has been carried out, including epidemiology. Results: A total of 110 patients, 58 men and 52 women, with a mean age of 40.8 years have been studied. Of the total, 25 patients have been treated surgically and 85 by endovascular embolization. In this study, the clinical neurological situation at admission, the volume and distribution of blood on computed tomography and the patient's age appear to be the most influential variables in the final result. Discussion: It has been established that the best management in this type of patients is the performance of computed tomography of the skull and cerebral arteriography, as well as admission for surveillance in the ICU. Surgery continues to play an important role in the treatment of aneurysms that cause subarachnoid hemorrhage, and the indications of endovascular embolization are increasingly well defined. Endovascular embolization is a safe and effective method in the treatment of cerebral aneurysms.Sin financiaciónNo data JCR 20200.125 SJR (2020) Q4, 154/165 NeurologyNo data IDR 2020UE

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale