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Introducción: el 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaró una pandemia, provocada por un nuevo coronavirus SARS-CoV-2. El rápido aumento de transmisiones obligó a gobiernos y autoridades sanitarias a tomar medidas para frenar el avance de la pandemia. Tras la primera ola epidémica y con un descenso documentado en el número de casos, comenzó la desescalada de las medidas implantadas y el desconfinamiento de la población. En este momento epidemiológico quisimos analizar la actividad asistencial pediátrica llevada a cabo, con objeto de conocer el modelo de consulta realizado (presencial/no presencial), los motivos de consulta atendida y el grado de resolución. Material y métodos: estudio descriptivo, observacional y retrospectivo sobre los pacientes atendidos en las consultas de Pediatría de Atención Primaria en un centro de salud de la ciudad de Madrid, durante el mes de junio de 2020. Resultados: se atendieron un total de 1321 pacientes, 34% menos que el mismo período del año anterior. La modalidad de consulta realizada fue presencial en un 49% y no presencial en el 51%. La consulta telefónica fue la opción mayoritaria como alternativa a la presencial. Un 20,7% del total de motivos de consulta fueron atendidos vía telemática. Conclusiones: tras la crisis sanitaria ocasionada por la COVID-19 la modalidad de atención no presencial ha adquirido protagonismo y mayor grado de resolución en nuestras consultas pediátricas. Pensamos que debe potenciarse mediante la incorporación de herramientas telemáticas, y así coexistir y complementar al modelo habitual de atención presencial (AU)

Introduction: on March 11, 2020, the World Health Organization (WHO) declared the outbreak caused by the novel coronavirus SARS-CoV-2 a pandemic. The rapid increase in cases forced governments and health authorities to take measures to contain the pandemic. After the first wave, when there was evidence of a decline in the number of cases, reopening started with progressive lifting of containment measures and ending the confinement of the population. Our objective was to analyse paediatric care delivery in our primary care centre at this point in the pandemic to determine the modalities of care delivery used (in-person/remote), the reasons for consultation in the total provided services and the degree of successful resolution of the reason for consultation.Material and methods: prospective, observational and descriptive study of the patients managed by the paediatrics clinic of a primary care centre in the city of Madrid, Spain, in June 2020. We collected data from the paediatric primary care electronic health records system of Madrid.Results: a total of 1321 patients were treated, 34% fewer compared to the same period the previous year. Forty-nine percent of consultations were managed in-person at the site and 51% remotely. Telephone consultations were the most frequent alternative to in-person visits. Of all the reasons for consultation, 20.7% were managed remotely.Conclusion: in the wake of the public health emergency brought on by COVID-19, the remote care modality has become prevalent and grown as a means to resolve patient needs and presenting complaints in our paediatric primary care clinic. We believe that this care modality should be reinforced with digital tools so that it can supplement and coexist with the conventional model of in-person care delivery. (AU)

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Objetivo. Las comunidades terapéuticas (CT) constituyen uno de los tratamientos más extensos para las drogodependencias; sin embargo, su investigación es escasa. El objetivo fue realizar una revisión sistemática para conocer los elementos metodológicos de los estudios de seguimiento a corto plazo y, a su vez, describir las consecuencias de las CT. Material y método. Se aplicó el "Preferred Reporting Items for Systematic reviews and meta-Analyses" (PRISMA) para la búsqueda en Medline, PsycINFO, PsycARTICLES y PsycCRITIQUES de estudios de seguimiento a corto plazo de CT entre 1980 y 2010. Resultados. El seguimiento consiste en un registro inicial y, al menos, otro al medio año de tratamiento; la muestra mínima contiene 60 usuarios con una mayor prevalencia de hombres solteros; el 50% continúa en seguimiento y/o alcanza la abstinencia. Conclusión. Las CT parecen ser beneficiosas para el ajuste del consumo y otros aspectos psicosociales, aunque la falta de información dificulta garantizar la comparación de estos hallazgos (AU)

Objetive. The therapeutic communities (TC) constitute one of the most extensive treatments for the drug dependencies; however, its investigation is scarce. The aim to do a systematic review to know the methodological elements of the short term follow-up studies and, at the same time, describe the consequences of the TC. Material and method. It was applied the "Preferred Reporting Items for Systematic reviews and meta-Analyses" (PRISMA) for the search in Medline, PsycINFO, PsycARTICLES and PsycCRITIQUES, in order to locate short-term follow-up studies of TC between 1980 and 2010. Results. The follow-up consists in an initial register and, at least, another to half year of treatment; the minimum sample contains 60 users with a greater prevalence of single men; 50% continues in follow-up and/or reaches the abstinence. Conclusion. The TC seem to be beneficial for the adjustment of the consumption and other psychosocial aspects, although lacking information difficult the comparability of these findings (AU)

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INTRODUCTION: Orthopedic implant infections are significant because of their morbidity, a tendency to serious relapses and an elevated health cost. OBJECTIVES: To study prognostic factors and the influence of long-term antibiotic treatment on the evolution of orthopedic implant infections. METHODS: This prospective study was performed in 110 patients with orthopedic implant infections. Clinical, analytical, and microbiological studies, as well as gammagraphy with Tc, Ga and labeled leukocytes, were performed in all patients. Controls were carried out at 7, 15 and 30 days after starting treatment, every 3 months thereafter until the end of treatment, and every 6 months thereafter up to one year after stopping treatment. Initial antibiotic treatment was prescribed according to the epidemiological characteristic of the type of infection and was modified according to the microorganism isolated. Duration of treatment was established by patient and implant characteristics, severity of infection and evolution of the process, and it was adjusted to criteria of cure, failure and relapse. RESULTS: Among the 110 cases, 63 were women and 37 men, with a mean age of 59.6 years (range 18-79 years). Implants included 72 joint prostheses (42 knee, 29 hip and 1 shoulder) and 38 bone implants. Microbiological documentation was obtained in 60%; among these, 60.6% were gram-positive cocci, with a predominance of staphylococci, 33.3% were gram-negative bacilli and 6.1% were anaerobic microorganims. Prognostic factors significantly associated with failure or relapse included previous joint surgery, previous hospital stay longer than 15 days, diabetes, microbiological isolation and treatment with cefuroxim plus rifampicin. Mean treatment duration was 9.8 months (range 2-17 months). Antibiotic treatment consisted of the following: 61 cases received fluorquinolones or cotrimoxazole plus rifampicin, 29 received cefuroxime-axetil plus rifampicin and the remaining 20 received monotherapy. Among 110 cases, 91 cured (83%). Treatment failures or relapses were observed in 19 (17%) patients; 26.7% of the latter were related to the implants. Tolerance to long-term antibiotic treatment was good.Conclusion. Long-term antibiotic treatment lasting a mean of 9.8 months had a positive influence on the evolution of orthopedic implant infections.

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INTRODUCCIÓN. Las infecciones de los implantes osteoarticulares (IOA) son de gran importancia por su morbilidad, tendencia a mayores recidivas y elevado coste sanitario. OBJETIVOS. Estudio de los factores pronósticos y la influencia del tratamiento antibiótico prolongado en su evolución. MÉTODOS. Se han estudiado de forma prospectiva 110 pacientes diagnosticados de infecciones de implantes osteoarticulares. En todos los pacientes se realizaron estudios clínicos, analíticos, microbiológicos y gammagráficos con tecnecio, galio y leucocitos marcados, efectuándose controles a los 7, 15, 30 días del inicio y después cada 3 meses hasta el final del tratamiento y después cada 6 meses hasta un año después de su suspensión. El tratamiento antibiótico inicial se realizó de acuerdo con las características epidemiológicas según el tipo de infección, modificándolo en relación con los microorganismos aislados. La duración del tratamiento se estableció en función del tipo de paciente, prótesis, gravedad de la infección y curso evolutivo. Su evolución se ajustó a los criterios de curación, fallo y recidiva. RESULTADOS. De los 110 casos, 63 eran mujeres y 37 varones con una edad media de 59,6 años (límites, 18 y 79 años). De ellos, 72 correspondían a prótesis articulares (42 de rodilla, 29 de cadera y uno de hombro) y 38 a implantes óseos. El 60 por ciento de los episodios se documentaron microbiológicamente. El 60,6 por ciento estuvieron causados por cocos grampositivos con predominio del género estafilococo, el 33,3 por ciento por bacilos gramnegativos y el 6,1 por ciento por anaerobios. Como factores pronósticos asociados a fracasos o recidivas se encontró de forma significativa la cirugía articular previa, una estancia hospitalaria previa superior a 15 días, la presencia de diabetes, la documentación microbiológica y el tratamiento antibiótico con cefuroxima más rifampicina. La duración media del tratamiento fue de 9,8 meses (límites, 2 y 17 meses). El tratamiento antibiótico fue el siguiente: 61 pacientes recibieron fluorquinolonas o cotrimoxazol más rifampicina y 29 cefuroxima-axetilo más rifampicina. Los restantes 20 pacientes recibieron un solo antibiótico. De los 110 casos, 91 (83 por ciento) evolucionaron hacia la curación. Los fracasos o las recidivas se observaron en 19 enfermos (17 por ciento del total de IOA y 26,7 por ciento en relación de las prótesis articulares) que requirieron la retirada de la prótesis. La tolerancia al tratamiento antibiótico prolongado fue buena. CONCLUSIÓN. El tratamiento antibiótico prolongado, con una duración media de 9,8 meses, influye positivamente en la mejor evolución de los IOA (AU)

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INTRODUCCIÓN. La infección protésica es una complicación grave por los problemas diagnósticos que plantea. OBJETIVOS. Estudiar las características epidemiológicas y clínicas de las infecciones asociadas a prótesis articulares para mejorar su diagnóstico y manejo. PACIENTES Y MÉTODOS. Desde diciembre de 1992 hasta diciembre de 1999, hemos evaluado de forma prospectiva a 110 pacientes con infecciones de prótesis articulares. El diagnóstico se llevó a cabo siguiendo criterios clínicos, microbiológicos y radiológicos, aceptados para este tipo de estudios. RESULTADOS. Su incidencia fue del 5,1 por ciento, 110 casos de 1.400 implantes articulares insertados durante el período de estudio. La edad media fue de 59,6 años (intervalo, 18-79 años), en su mayoría mujeres, 63 (57,2 por ciento).Su localización más frecuente fue la rodilla, 42 casos (38 por ciento), la cadera, 29 (26 por ciento), el hombro, 1 (1 por ciento) e implantes óseos, 38 (34 por ciento). En 29 pacientes (26,3 por ciento) se encontraron enfermedades de base, entre las que destacaba diabetes en 17 casos. Como antecedentes más importantes figuraba el uso previo de antibióticos en 58 pacientes (51 por ciento), a expensas principalmente de ciprofloxacino. Se documentaron microbiológicamente 66 casos (60 por ciento), y se aislaron grampositivos, 58,2 por ciento y gramnegativos, 32,8 por ciento, a expensas fundamental de Staphylococcus sp.y P. aeruginosa respectivamente, encontrándose anaerobios en 9 por ciento. De todos los casos, 67 eran infecciones precoces, 25 intermedias y 18 tardías, y todos los casos presentaron dolor y signos inflamatorios. En 46 casos (41,8 por ciento) se detectó fístula con supuración, y sólo 5 casos (4,8 por ciento) fiebre. CONCLUSIONES. La infección es una complicación importante tras el implante de prótesis articular; está causada, fundamentalmente, por cocos grampositivos y presenta clínicamente una mayor afectación local que sistémica (AU)

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UNLABELLED: The presence of affected locoregional lymph nodes should be considered as one of the most important prognostic factors of breast cancer. At present, the clinician is conditioned by an absolute lack of an efficient methodology to evaluate the possible invasion of the axillary lymph nodes, which if negative, would make it possible to avoid surgical excision. In this study, we will evaluate the use of the 99mTc-MIBI scintigraphy in the pre-surgical diagnosis of axillary lymph node invasion and will analyze the relationship between the 99mTc-MIBI uptake and the number of lymph nodes affected. MATERIAL AND METHODS: 84 patients diagnosed of breast cancer were analyzed in this study. All of them underwent a 99mTc-MIBI scintigraphy, and the tumor/background ratio was determined semiquantitively for each image. The axillary lymph node invasion was determined following surgery. RESULTS: The sensitivity of the breast scintigraphy with 99mTc-MIBI for detection of lymph node invasion is 36% and the specificity is 100%. The positive predictive value is 100% and the negative one 48%. In the current study, we failed to detect correlation between the intensity of 99mTc-MIBI uptake in the primary tumor and the number of affected axillary lymph nodes. CONCLUSION: 99mTc-MIBI breast scintigraphy can provide complementary information for the presurgical diagnosis of breast cancer axillary lymph node invasion. 99mTc-MIBI breast scintigraphy shows high specificity and a high predictive value.

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UNLABELLED: (99m)Tc-MIBI has been proposed as an imaging diagnostic method in a large variety of human malignant tumors. At present, the mechanism by which (99m)Tc-MIBI is uptaken and concentrated by the malignant cells is not totally known. Some mammary neoplasms do not show any uptake of (99m)Tc-MIBI. This study aims to determine if there is any correlation between the uptake of (99m)Tc-MIBI by the tumor and the different histopathological parameters involved in tumoral aggressiveness. To do so, we have studied 100 patients with breast cancer. All of them underwent a breast scintimammography with (99m)Tc-MIBI with semiquantitative analysis by means of a tumor-to-background ratio calculated in every projection. After surgery, an experienced pathologist determined tumor size, axillary lymph node metastases, histological grade (Scarff Bloom Richardson) (SCBR), nuclear grade, mitotic index, presence of cellular atypia and estrogen and progesterone receptor expression. RESULTS: A statistically significant correlation (p < 0.005) has been found between tumor-to-background (T/B) ratios of (99m)Tc-MIBI uptake and tumor SCBR histological grade. A correlation between (99m)Tc-MIBI uptake and the mitotic index, cellular atypia and nuclear grade has also been found. No correlation was found in our study with tumor size, hormone receptor expression or axillary lymph node metastases. CONCLUSIONS: (99m)Tc-MIBI uptake in breast cancer is correlated with the tumoral differentiation grade: the smaller the tumoral cellular differentiation (greater aggressiveness), the greater the uptake. On the other hand, no correlation was found between the uptake of (99m)Tc-MIBI and the classical pathological parameters that define tumoral aggressiveness, such as size and axillary lymph node metastasis.

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The aim of this study was to analyze the possible relation of biochemical, cytologic, and morphologic parameters to the results of parathyroid gammagraphy with Tc 99m sestamibi in primary hyperparathyroidism. We studied 46 consecutive patients with primary hyperparathyroidism who were undergoing surgery. All the patients were given a preoperative parathyroid gammagraphy with Tc 99m sestamibi and a complete preoperative biochemical study. During the surgical intervention we recorded the weight and size of the pathologic glands to calculate the volume of each. We also determined the percentage of the chief and oxyphil cells in the pathologic glands. Tc 99m sestamibi sensitivity is higher in adenomas (91%) than in hyperplasia (67%) or double adenomas (50%). No relation was found between biochemical or cytologic parameters and gammagraphic results. Weight and gland volume were significantly greater for adenomas than for hyperplasia (P < 0.0014 and P < 0.0004, respectively), and statistically significant differences in both of them were observed between the glands with positive and negative sestamibi.

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Hand dermatitis is a frequent problem among workers in milk testing laboratories. An epidemiologic study was conducted at the Pennsylvania Dairy Herd Improvement Association Milk Testing Laboratory, where more than 300,000 milk samples are examined monthly for protein, butterfat, and "somatic" cells. These samples are preserved with potassium dichromate for transport from the farm to the laboratory. A survey of the laboratory was conducted and workers were interviewed. Eight of 16 subjects reported a history of occupationally exacerbated hand dermatitis. Three of 16 subjects had positive patch test results to potassium dichromate. Two of 15 subjects who underwent patch testing to milk preserved with potassium dichromate had positive reactions. None reacted to milk alone, bronopol, or Kathon CG. Two workers are receiving workers' compensation because of severe allergic contact dermatitis of the hands to potassium dichromate. We conclude that milk testing laboratory workers are at substantial risk for acquiring allergic contact dermatitis from milk preserved with potassium dichromate.

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