Escalas de valoración del dolor en pacientes con demencia. Instrumentos de ayuda para el fisioterapeuta,el médico,el enfermero y el terapeuta ocupacional

The purpose of this study was to determine which scales are being used to evaluate pain in old people suffering from dementia.     

Revisión sobre el deterioro funcional en el anciano asociado al ingreso por enfermedad aguda

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.     

¿Existe el obeso sano?

It is currently postulated that not all obese individuals have to be considered as pathological subjects. From 10% to 20% of obese people studied do not show the metabolic changes common in obese patients. The term «healthy obese» has been coined to refer to these patients and differentiate them from the larger and more common group of pathological obese subjects. However, the definition of «healthy obese» is not clear. Use of «healthy obese» as a synonym for obese without metabolic complications is risky. Clinical markers such as insulin resistance are used to identify this pathology. It is not clear that healthy obese subjects have lower morbidity and mortality than pathologically obese patients. According to some authors, healthy obese would represent an early stage in evolution towards pathological obesity. There is no agreement as to the need to treat healthy obese subjects.     

Guía para el diagnóstico y tratamiento de la insuficiencia suprarrenal en el adulto

Adrenal insufficiency (AI) is a disease characterized by a deficient production or action of glucocorticoids, with or without deficiency in mineralcorticoids and/or adrenal androgens. It can result from disease intrinsic to the adrenal cortex (primary AI), from pituitary diseases that hamper the release of corticotropin (secondary AI) or from hypothalamic disorders that impair the secretion of the corticotropin-releasing hormone (tertiary AI).It is a disease with a low prevalence but its impact on the affected individual is very high as it can be life-threathening if not treated or lead to health problems if inadequately treated. However, currently there are no specific guidelines for the management of this disease. Therefore, at the proposal of the Spanish Society of Endocrinology and Nutrition (SEEN) board, a task-force under the Neuroendocrinology Knowledge Area of the SEEN was established, with the mandate of updating the diagnosis and treatment of AI. In fulfilment of this mandate the task-force has elaborated the present guide that, based on a comprehensive review of literature, is intended to provide an answer to questions related to the management of this disease. It is, therefore, an essentially practical document, mainly aimed at guiding the health professionals involved in the care of IA patients.     

Utilidad clínica de la micafungina en el tratamiento de las candidiasis invasoras en el neonato

BackgroundIn neonatal intensive care units, deep fungal disease due to Candida spp. are an important clinical problem, partly due to the increasing prevalence of Candida disease and also to the high associated and constant morbimortality; both factors are independently maintained though there has been a significant improvement in the management of neonatal patients.AimsTo define the therapeutic use of micafungin for the treatment of neonatal invasive candidiasis.MethodsWe use a review of biomedic data bases namely Medline and EMBASE.ConclusionsMicafungin is the latest introduced echinocandin. It has a wide spectrum of activity and covers Candida albicans and non-albicans Candida species. It has scarce drugs interactions and is devoid of toxicity, being an attractive approach for the treatment of invasive candidiasis (without meningitis, endocarditis and endophthalmitis). Althought the European Medicines Agency approved in 2008 the use of Micafungin for the treatment of invasive candidiasis in children, the available clinical experience is limited and currently more clinical studies are warranted to define its efficacy and safety in neonates.     

Infecciones por mohos en el trasplante pulmonar

Invasive infections by molds, mainly Aspergillus infections, account for more than 10% of infectious complications in lung transplant recipients. These infections have a bimodal presentation: an early one, mainly invading bronchial airways, and a late one, mostly focused on lung or disseminated. The Aspergillus colonization at any time in the post-transplant period is one of the major risk factors. Late colonization, together with chronic rejection, is one of the main causes of late invasive forms. A galactomannan value of 0.5 in bronchoalveolar lavage is currently considered a predictive factor of pulmonary invasive infection. There is no universal strategy in terms of prophylaxis. Targeted prophylaxis and preemptive treatment instead of universal prophylaxis, are gaining more followers. The therapeutic drug monitoring level of azoles is highly recommended in the treatment. Monotherapy with voriconazole is the treatment of choice in invasive aspergillosis; combined antifungal therapies are only recommended in severe, disseminated, and other infections due to non-Aspergillus molds.     

Pueblos indígenas ante el derecho

Pueblos indígenas ante el derecho. Victoria Chenaut and Maria Teresa Sierra. eds. Mexico City: Centro de Investigaciónes. Estudios Superiores en Antropología Social; Centro Francés de Estudios Mexicanos Centroamericanos, 1995. 370 pp.     

Micetomas y procesos premicetomatosos en el Uruguay

Resumen La casuística uruguaya incluye 5 casos de micetomas y 5 procesos considerados premicetomatosos.Los micetomas fueron producidos por mohos en 2 oportunidades y por nocardias en las 3 restantes. Los mohos responsables fueron Scedosporium apiospermum en un caso y Rubromadurella langeroni en el otro aunque aquí el autor no obtuvo cultivos. Nocardia asteroides fué el agente de 2 casos de micetomas mientras que en el tercero no se lograron cultivos.Tres micetomas pudieron ser diagnosticados en una etapa bien temprana consiguiéndose curaciones fáciles por procedimientos médicos o quirúrgicos. En los 2 restantes el diagnóstico fué tardío y hubo que recurrir a la amputación del miembro afectado.A propósito del micetoma de miembro superior por S. apiospermum se propone hablar de una nueva forma clínica de micetoma: la forma linfangítica.Los procesos premicetomatosos incluyen 3 casos de nocardiasis linfangitica de miembros superiores por N. brasiliensis, un absceso de hombro por la misma especie y una artritis tibiotarsiana fistulizada por N. asteroides. Todos ellos fueron curados en cortos espacios de tiempo.El diagnóstico precoz del micetoma y cuadros clínicos relacionados en el Uruguay se atribuye a la consulta médica temprana lo que a su vez sería consecuencia primaria de la no existencia de obstáculos de importancia en las comunicaciones entre un sitio y otro del territorio nacional.

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Summary Five cases of mycetomas and 5 premycetomatous lesions have been recorded in Uruguay.Two mycetomas were produced by fungi and three by nocardias. The causal fungi were identified as Scedosporium apiospermum in one case and Rubromadurella langeroni in the other. Nocardia asteroides was isolated from 2 cases and no cultures were obtained from the remaining one.Three mycetomas were diagnosed in an early stage of development and easy cures were obtained through medical or surgical procedures. In the other two cases the diagnosis was made in a late stage and the final result was amputation.A new clinical form of mycetoma called lymphangitic is proposed after describing a patient with mycetoma of the forearm and arm by S. apiospermum.Premycetomatous lesions included 3 cases of lymphangitic nocardiasis of the arm by N. brasiliensis, an abscess of the shoulder by the same species and an arthritis of the ankle by N. asteroides. All were cured after short periods of therapy.The usual early diagnosis of mycetomas and related diseases un Uruguay is considered to be the result of a prompt medical consultation due mainly to the abscence of important geographical obstacles in the Country.

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Se analiza la casuística uruguaya de micetomas y procesos premicetomatosos junto a sus agentes causales.A propósito de un micetoma de miembro superior por Scedosporium apiospermum se propone una nueva forma clinica de micetoma: la forma linfangítica.Se destaca la importancia del diagnóstico precoz del micetoma y el por qué ello es factible en el Uruguay.