We present the cases registred from 1998 to 2003 and a revision of the bibliography.
In the section of Rhinology of a second level Hospital 11 patients affected by inverted papilloma type 1 of the ...OMS classification were diagnosed aged between 40 and 79, 9 men and 2 women. They were explored through endoscopy and biopsy and the exeresis of the lesion was done by endoscopic polipectomy with microdebrider (PEM).
All the cases at stage I, II and III of the Krouse classification. Treated by CEN, 6 by mixed endonasal approach and through the canine fossa 4 by nasal approach only and 1 by Caldwell-Luc approach. The follow-up was done between 9 to 64 months and there was a recidive who was operated by open surgery and no one malignant transformation was seen.
We coment the aspects related to etiology, the symptons and the surgical technics.
We propose to stage the tumor and the realisation of a PEM with topic anesthesia with deep biopsies in all unilateral poly formations to avoid a retarded diagnosis and to be able to apply endoscopic technics.
ABSTRACT
The purpose of this study was to design and validate a complex gait test (CGT) in preschool children and to examine the relationship between CGT performance and age, sex, and cognitive ...functioning. A total of 1,040 preschool children, aged 3 to 6 years, participated in this study. In all children, standardized dynamic balance test, and several cognitive functioning measures were used. The results indicate that the CGT has adequate reliability and validity. In the test–retest analysis (n = 90), the intraclass correlation coefficient was 0.901 (p < .001). A significant correlation between the initial test and retest (r = 0.821, p < .001) and between the CGT and dynamic balance test (r = −0.432, p < .001), Porteus Maze Test (PMT) (r = −0.416, p = .011), and Goodenough‐Harris Drawing Test (GHDT) (r = −0.386, p < .001) was found. Boys showed a better performance than girls at 3–6 years old. The CGT showed excellent reliability and validity in preschool children and may serve as a potential biomarker in cognitive development.
Lay : We designed and validated a complex gait test in preschool children. Moreover, we analyzed the relationship between the complex gait test and physical functioning and cognitive measures. The results indicate that the complex gait test reported adequate reliability and validity parameters, showing in boys a better performance than girls at 3–6 years old. Therefore, the findings indicate this novel complex gait test shows very good reliability and validity in preschool children aged 3–6 years.
The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of ...competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites.
Observational multicenter study.
Thirteen Spanish ICU Departments.
Thirty six R3.
The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters.
Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency.
A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64–0.79). Inter-rater reliability was strong median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65–0.97). Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed.
The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency.
COBALIDATION. NCT04278976. (https://register.clinicaltrials.gov).
El modelo de formación en medicina intensiva (MI) en España se basa en la experiencia adquirida durante una serie de rotaciones programadas por diferentes áreas clínicas. El objetivo principal del estudio fue determinar el nivel de competencia (I principiante – V autónomo) de los residentes de MI al finalizar el tercer año de residencia (R3) mediante una ECOE basada en simulación. Objetivos secundarios: 1) identificar brechas en el desempeño; 2) investigar la fiabilidad y validez de una ECOE simulada multicéntrica como método de evaluación.
Estudio multicéntrico observacional.
Trece servicios españoles de Medicina Intensiva.
Treinta y seis R3.
Los 36 R3 participaron en cinco escenarios clínicos simulados de 15 minutos de duración en cuatro centros de simulación. Las actuaciones se grabaron en video y posteriormente se calificaron por pares de expertos.
Un panel de intensivistas expertos seleccionó mediante el método Delphi los elementos críticos esenciales de cada escenario para definir los niveles de competencia.
La consistencia interna de los listados de verificación fue adecuada (KR-20:0,64-0,79). La fiabilidad interjueces fue elevada (coeficiente de correlación intraclase mediana: 0,89 0,65-0,97). Los niveles de competencia conseguidos fueron: nivel I (18,8%), II (35,2%), III (42,6%), IV/V (3,4%). Globalmente, se observó una gran heterogeneidad en el desempeño.
El nivel de competencia esperado se logró únicamente en la mitad de las actuaciones. Se necesita un modelo de formación más basado en objetivos y evidencias. La evaluación mediante escenarios simulados en múltiples centros demostró ser factible y fiable.
The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of ...competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites.
Observational multicenter study.
Thirteen Spanish ICU Departments.
Thirty six R3.
The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters.
Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency.
A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64–0.79). Inter-rater reliability was strong median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65–0.97). Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed.
The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency.
COBALIDATION. NCT04278976. (https://register.clinicaltrials.gov).
El modelo de formación en medicina intensiva (MI) en España se basa en la experiencia adquirida durante una serie de rotaciones programadas por diferentes áreas clínicas. El objetivo principal del estudio fue determinar el nivel de competencia (I principiante – V autónomo) de los residentes de MI al finalizar el tercer año de residencia (R3) mediante una ECOE basada en simulación. Objetivos secundarios: 1) identificar brechas en el desempeño; 2) investigar la fiabilidad y validez de una ECOE simulada multicéntrica como método de evaluación.
Estudio multicéntrico observacional.
Trece servicios españoles de Medicina Intensiva.
Treinta y seis R3.
Los 36 R3 participaron en cinco escenarios clínicos simulados de 15 minutos de duración en cuatro centros de simulación. Las actuaciones se grabaron en video y posteriormente se calificaron por pares de expertos.
Un panel de intensivistas expertos seleccionó mediante el método Delphi los elementos críticos esenciales de cada escenario para definir los niveles de competencia.
La consistencia interna de los listados de verificación fue adecuada (KR-20:0,64-0,79). La fiabilidad interjueces fue elevada (coeficiente de correlación intraclase mediana: 0,89 0,65-0,97). Los niveles de competencia conseguidos fueron: nivel I (18,8%), II (35,2%), III (42,6%), IV/V (3,4%). Globalmente, se observó una gran heterogeneidad en el desempeño.
El nivel de competencia esperado se logró únicamente en la mitad de las actuaciones. Se necesita un modelo de formación más basado en objetivos y evidencias. La evaluación mediante escenarios simulados en múltiples centros demostró ser factible y fiable.
is a human zoonotic pathogen of occupational origin, with infection acquired through contact with live pigs or pig meat. Pig farming is one of Catalonia's biggest industries and as a result this ...region of Spain has one of the highest density pig populations per km
. The aim of our study was to describe the infections caused by
occurring in that area over a 9-year period.
A retrospective, multi-center study was carried out by searching records from 15 hospitals in Catalonia for the period between 2010 and 2019.
Over the study period altogether nine cases of
infection were identified in five hospitals, with five of these cases occurring in the 2018-2019 period. The mean age of patients was 48 ± 8.9 years and all of them were males. Five patients (55.6%) worked in pig farms. The most frequent manifestation of infection was meningitis (5 cases; 55.6%) followed by septic arthritis (3 cases; 33.3%). None of the patients died at 30 days; nonetheless, 4 developed hearing loss as a long-term complication.
The most commonly identified
infection was meningitis. Over 50% of the episodes occurred in the last 2 years and have affected pig farm workers. Further surveillance is needed in order to know its prevalence.
The aim of the present study was to gather information regarding the molecular epidemiology of Human papillomavirus (HPV) and related risk factors in a group of women with low- and high-grade ...cervical lesions and cancer from the coastal region of Ecuador. In addition, we studied the evolution of HPV variants from the most prevalent types and provided a temporal framework for their emergence, which may help to trace the source of dissemination within the region. We analyzed 166 samples, including 57 CIN1, 95 CIN2/3 and 14 cancer cases. HPV detection and typing was done by PCR-sequencing (MY09/MY11). HPV variants and estimation of the time to most recent common ancestor (tMRCA) was assessed through phylogeny and coalescence analysis. HPV DNA was found in 54.4% of CIN1, 74.7% of CIN2/3 and 78.6% of cancer samples. HPV16 (38.9%) and HPV58 (19.5%) were the most prevalent types. Risk factors for the development of cervical lesions/cancer were the following: three or more pregnancies (OR=4.3), HPV infection (OR=3.7 for high-risk types; OR=3.5 for HPV16), among others. With regard to HPV evolution, HPV16 isolates belonged to lineages A (69%) and D (31%) whereas HPV58 isolates belonged only to lineage A. The period of emergence of HPV16 was in association with human populations (tMRCA=91052 years for HPV16A and 27000 years for HPV16D), whereas HPV58A preceded Homo sapiens evolution (322257 years). This study provides novel data on HPV epidemiology and evolution in Ecuador, which will be fundamental in the vaccine era.
El objetivo del presente estudio fue aportar información sobre la epidemiología molecular del virus del papiloma humano (human papillomavirus HPV) y los factores de riesgo asociados al desarrollo de lesiones cervicales y cáncer en mujeres de la costa del Ecuador. Además, se estudiaron la evolución de las variantes de los HPV más prevalentes y el marco temporal de su emergencia, para ayudar a rastrear la fuente de dispersión en la región. Se analizaron 166 muestras, incluyendo 57 y 95 casos de neoplasia intraepitelial cervical tipo 1 (CIN1) y tipo 2/3 (CIN2/3), respectivamente, y 14 de casos de cáncer. La detección/tipificación de HPV se realizó por PCR-secuenciación (MY09/MY11). La caracterización de variantes y la datación del ancestro común más reciente (tMRCA) se realizaron mediante filogenia y coalescencia. Se encontró ADN de HPV en el 54,4% de las muestras de CIN1, el 74,7% de las muestras de CIN2/3 y el 78,6% de las muestras de cáncer. Los tipos HPV16 (38,9%) y HPV58 (19,5%) fueron los más frecuentes. Los factores de riesgo para el desarrollo de lesiones cervicales/cáncer fueron 3 o más embarazos (OR = 4,3) e infección por HPV (O = 3,7 para HPV de alto riesgo, OR = 3,5 para HPV16), entre otros. En cuanto a la evolución viral, los aislados del HPV16 pertenecían a los linajes A (69%) y D (31%), mientras que los aislados del HPV58 pertenecían únicamente al linaje A. El período de emergencia del HPV16 estuvo asociado a poblaciones humanas (tMRCA = 91.052 años para HPV16A y 27.000 para HPV16D), mientras que el del HPV58A precedió a la evolución de Homo sapiens (322.257 años). Este estudio proporciona datos novedosos sobre la epidemiología y la evolución del HPV en Ecuador, los cuales serán fundamentales en la era de la vacuna.
The availability of new agents for the treatment of multiple myeloma has allowed the use of multiple lines of treatment, but a percentage of patients do not reach to receive this combination because ...of toxicity and early death. In this regard, a cross-sectional European study evaluated the management of different lines and discontinuation of treatment in 7635 patients from seven countries in routine clinical practice, finding that 39% of European patients do not receive a second line and that only 4% of patients reach third line in Spain, a figure that is striking when comparing with the rest of the countries. We analyze the frequency and causes of treatment discontinuation in a series of 108 patients from a Spanish University hospital showing that the main reason for permanent treatment discontinuation after finishing first line was to have a response, while death due to disease progression accounted for the main reason in subsequent lines of therapy, with its frequency increasing according to the number of lines received. Additionally, in our longitudinal study, we estimated, using a competitive risk analysis, that 22% of patients would not receive a second line of therapy at 60 months and 47% would not reach third line, also at 60 months, showing a marked discrepancy with the results reported in the cross-sectional European study. Although based on limited data, our results suggest the convenience of validating the findings of cross-sectional studies conducted in large cohorts.
El proceso dialéctico de formación y educación de la personalidad integral como proceso dirigido al desarrollo humano, desde una dimensión social, constituye en la educación secundaria básica un ...espacio de socialización, en el cual los y las adolescentes se apropian de la cultura y los valores que favorecen su desarrollo personal y grupal como vía para enfrentar los permanentes cambios que la sociedad impone a los adolescentes en sus diferentes contextos de actuación. El presente trabajo de investigación tendrá como bases, varias postulaciones psicológicas fundamentadas desde dicha teoría y el aporte psiquiátrico, cuya aportaciones teóricas hacen referencia a la conducta disocial y el establecimiento de límites, los cuales se relacionan con los objetivos planteados y la propuesta a desarrollar. La correlación de la conceptualización con ciertos aspectos del sujeto hace de la investigación una lectura analítica sobre las dinámicas del fenómeno a abordar, con el objetivo de identificar la conducta disocial en la capacidad para establecer límites, en jóvenes de 12 a 17 años, del centro educativo “Edulfo Estrada” Montecristi, encaminado a disminuir conductas disociales, ofreciendo talleres y asesorías psicológicas.
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