Programa multicomponente para la mejora de la comprensión emocional en niños preescolares

La comprensión emocional constituye una de las áreas más importantes del desarrollo de los niños en los años preescolares y para los posteriores años de la vida de niños y adultos. Se presentan los resultados de la implementación y evaluación de la efectividad de un programa multicomponente para fomentar la comprensión emocional en niños de grado Transición del Colegio Agustín Fernández. Se realizó un estudio mixto explicativo con 15 niños preescolares entre los 5 y los 6 años de edad. Para tal propósito, se evaluó con la plataforma digital de Comprensión Emocional (Bermúdez-Jaimes, 2008) que consta de 9 tareas (Reconocimiento de emociones, Causa externa, Deseo, Creencia, y Recordatorio, Regulación, Ocultación, Mezcla y Moralidad). Posteriormente, se procedió a implementar el programa multicomponente y se realizó una evaluación post-test. Asimismo, se realizaron entrevistas a padres de familia y a la profesora, las cuales se transcribieron e interpretaron a partir de dos categorías previamente identificadas: Información sobre la vida de los niños y Transiciones en el desarrollo emocional de los niños. Los resultados mostraron que existe una diferencia estadística significativa evidenciando que el programa de intervención implementado mejoró los niveles de comprensión emocional en niños de transición (t(15)= 5,99; = 0,00**) y las narraciones de los padres de familia y la profesora respaldaron dichos datos.Emotional understanding is one of the most important areas of development for children who go through the preschool and for the later years of children's and adult’s lives. The results of the implementation and evaluation of the effectiveness of a multicomponent program to promote emotional comprehension in preschool children of the Agustin Fernandez School are presented. A mixed explanatory study was conducted with 15 preschool children between 5 and 6 years of age. For this purpose, it was evaluated with the digital platform of Emotional Understanding (Bermúdez-Jaimes, 2008) which consists of 9 tasks (Recognition of emotions, External Cause, Desire, Belief, and Reminder, Regulation, Concealment, Mixing and Morality). Subsequently, the multicomponent program was implemented and a post-test evaluation was carried out. In addition, interviews were conducted with parents and the teacher, which were transcribed and interpreted from two previously identified categories: Information about the children's lives and Transitions in the children’s emotional development. The results showed that there is a significant statistical difference showing that the implemented intervention program improved the levels of emotional understanding in preschool children (t (15) = 5.99, p = 0.00 **) and that the narratives of the parents and the teacher support this data.Psicólogo (a)Pregrad

Cirrosis biliar primaria. Presentación de un caso clínico y revisión bibliográfica

La Cirrosis Biliar Primaria (CBP) es una enfermedad hepática colestásica-crónica y progresiva de patogenia autoinmune, que ha aumentado su prevalencia en los últimos años. En el presente trabajo exponemos un caso clínico sobre una paciente femenina con síndrome colestásico, anticuerpos anti-mitocondriales (AMA) positivo y el informe anatomopatológico compatible con CBP cirrosis biliar primaria en tercer estadío. Su tratamiento principal fue farmacológico con ácido ursodeoxicólico (AUDC)

Patrón gammagráfico “superscan†en la osteomalacia hipofosfatémica asociada a Tenofovir en un paciente con infección por VIH.

El tratamiento antirretroviral de gran actividad (TARGA) constituye uno de los avances más importantes en el manejo de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Sin embargo, su uso a largo plazo conlleva el riesgo de aparición de enfermedades óseas como la osteporosis y la osteonecrosis. Uno de los fármacos más utilizados dentro de los esquemas de TARGA es el tenofovir disoproxil fumarato (TDF), un análogo de nucleótido inhibidor de la transcriptasa inversa que tiene buen perfil de seguridad y tolerancia, pero que ha sido asociado con el desarrollo de osteomalacia hipofosfatémica (OMH). Presentamos el caso de un varón de 56 años con infección crónica por VIH que desarrolló dolor óseo generalizado y debilidad durante el tratamiento con TDF, detectándose en el estudio analítico hipofosfatemia y aumento de su nivel basal de fosfatasa alcalina, con fosfaturia y calciuria normales. La radiografía mostraba aplastamientos vertebrales dorsales y la gammagrafía ósea reveló una hipercaptación difusa compatible con patrón “superscan†metabólico. Este patrón ha sido descrito de forma infrecuente en la OMH asociada a TDF, por lo que realizamos una revisión de los casos previamente publicados. Â

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Guía de manejo diagnóstico y terapéutico de la artritis séptica en urgencias

La artritis séptica de articulaciones nativas (ASAN) es la urgencia reumatológica del aparato locomotor por excelencia. De su oportuno diagnóstico y tratamiento depende el pronóstico a corto y largo plazo. La ASAN es más frecuente en varones, entre la quinta y sexta décadas de la vida, afecta principalmente articulaciones grandes y su clínica habitual es la de una monoartritis con gran compromiso sistémico. La sospecha diagnóstica debe seguirse del estudio del líquido sinovial, de la instauración de terapia antibiótica intravenosa (IV) y hospitalización. En nuestro medio, el manejo en urgencias de esta patología es heterogéneo existiendo múltiples modelos de abordaje. Actualmente, las guías internacionales de manejo de la ASAN están basadas en escasos ensayos clínicos, múltiples series de casos y en la opinión de expertos. Hemos elaborado la presente guía basados en la información más relevante disponible con el propósito de homogenizar el desenvolvimiento médico diagnóstico y terapéutico de la ASAN tan pronto como el paciente es valorado por primera vez

Long-term pulmonary outcomes and mortality in idiopathic inflammatory myopathies associated with interstitial lung disease

Objective: To study prognostic factors in different types of idiopathic inflammatory myopathies (IIM) associated with interstitial lung disease (ILD). Patients and methods: Multicenter retrospective study of a Spanish cohort of patients diagnosed with IIM. Patients were classified into four categories: polymyositis (PM), dermatomyositis (DM), antisynthetase syndrome (ASS), and overlap myositis (OM). Sociodemographic data, clinical characteristics, antibodies, and treatments were collected. Cox regression models were calculated to identify factors associated with mortality, the necessity for long-term oxygen therapy (LTOT), and deterioration in respiratory function tests (RFT). Results: The number of patients included was 478, of whom 112 (23.4%) suffered from ILD: 17% PM, 16% DM, 45% ASS, and 22% OM. Factors associated with mortality in the multivariate analysis were clinically meaningful progression of ILD after 3 months (CMP 3m) (hazard ratio (HR) 9.48, p = 0.005), severe infections (HR 6.41, p = 0.016), heliotrope erythema (HR 31.1, p = 0.002), delay in diagnosis (HR 1.29; p = 0.011), and Raynaud's phenomenon (HR 11.9, p = 0.007). However, being female (HR 0.19, p = 0.044) and positivity solely for ANAs (HR 0.08, p = 0.008) presented a protective effect. CMP 3m (HR 22.7, p = 0.027) was associated with the need for LTOT, while basal aldolase (HR 0.90; p = 0.049) had a protective effect. Likewise, joint manifestations (HR 0.04, p = 0.034) were shown to reduce risk of deterioration in RFT. Conclusions: CMP 3m, severe infections, delay in diagnosis, heliotrope erythema, and Raynaud's phenomenon were identified as factors of poor prognosis in different IIM associated with ILD.Sin financiación2.394 JCR (2019) Q3, 20/32 Rheumatology0.755 SJR (2019) Q2, 27/64 RheumatologyNo data IDR 2019UE

Overlap myositis, a distinct entity beyond primary inflammatory myositis: A retrospective analysis of a large cohort from the REMICAM registry

Background: Inflammatory idiopathic myositis (IIM) comprises a heterogeneous group of systemic muscular diseases that can occur together with other connective tissue diseases (CTD), named overlap myositis (OM). The question of whether OM is a distinct entity still remains controversial. Aim: The present study was conducted to assess the clinical and prognostic differences between patients diagnosed with OM, primary polymyositis (PM) and primary dermatomyositis (DM). Method: The study consists of a retrospective longitudinal and multicenter series of IIM patients. Patients were classified as OM, PM and DM. Overlap myositis was defined as patients fulfilling criteria for IIM plus criteria for other CTD (namely systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, rheumatoid arthritis and primary Sjögren's syndrome). Result: A total of 342 patients were included (98 OM, 137 PM and 107 DM). Overlap myositis patients, in comparison with PM and DM, showed significant differences, with more extramuscular involvement, particularly more arthritis (66%, 34.6% and 48.1%, respectively), puffy fingers (49.5%, 11.1% and 24.3%), sclerodactyly (45.4%, 2.2% and 2%), dysphagia (41.8%, 18.2% and 26.4%), Raynaud phenomenon (65.3%, 16.9% and 19.8%), leucopenia (28.9%, 2.2% and 8.4%), thrombocytopenia (8.2%, 2.2% and 1.9%), interstitial lung disease (ILD) (48%, 35% and 30.8%), renal manifestations (13.4%, 3.7% and 1.9%), and more severe infections (41.3%, 26.7% and 21%). No significant differences were found in survival between groups in log rank test (P = 0.106). Multivariate adjusted survival analyses revealed a worse prognosis for severe infections, ILD and baseline elevation of acute phase reactants. Conclusion: Overlap myositis stands out as a distinct entity as compared to PM and DM, featuring more extramuscular involvement and more severe infections. Close monitoring is recommended in this subset for early detection and treatment of possible complications.Sin financiación1.980 JCR (2019) Q1, 25/32 Rheumatology0.649 SJR (2019) Q3, 33/64 RheumatologyNo data IDR 2019UE

Mortality and prognostic factors in idiopathic inflammatory myositis: a retrospective analysis of a large multicenter cohort of Spain

The present study was undertaken to assess mortality, causes of death, and associated prognostic factors in a large cohort of patients diagnosed with idiopathic inflammatory myositis (IIM) from Spain. A retrospective longitudinal study was carried out in 467 consecutive patients with IIM, identified from 12 medical centers. Patients were classified as primary polymyositis, primary dermatomyositis (DM), overlap myositis, cancer-associated myositis (CAM), and juvenile idiopathic inflammatory myopathies. A total of 113 deaths occurred (24%) after a median follow-up time of 9.7 years. In the overall cohort, the 2-, 5-, and 10-year survival probabilities were 91.9, 86.7, and 77%, respectively. Main causes of death were infections and cancer (24% each). Multivariate model revealed that CAM (HR = 24.06), OM (HR = 12.00), DM (HR = 7.26), higher age at diagnosis (HR = 1.02), severe infections (HR = 3.66), interstitial lung disease (HR = 1.61), and baseline elevation of acute phase reactants (HR = 3.03) were associated with a worse prognosis, while edema of the hands (HR = 0.39), female gender (HR = 0.39), and longer disease duration (HR = 0.73) were associated with a better prognosis. The standardized mortality ratio was 1.56 (95% CI 1.28-1.87) compared to the Spanish general population. Our findings indicate that IIM has a high long-term mortality, with an excess of mortality compared to the Spanish population. A more aggressive therapy may be required in IIM patients presenting with poor predictive factors.Sin financiación1.952 JCR (2017) Q3, 24/32 Rheumatology0.906 SJR (2017) Q2, 25/66 RheumatologyNo data IDR 2017UE