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Background: Musculoskeletal fibrosis can be frequently observed in the scope of sports medicine; however, there is no consensus regarding its definition, nor do we have substantial knowledge regarding its epidemiology or best therapeutic alternatives. Purpose: The GESMUTE (Group for the Study of the Muscle Tendon System) Epidemiology Group, integrated into SETRADE (The Spanish Society for Sports Traumatology) propose a definition for musculoskeletal fibrosis within the field of physical exercise. Study Design: Consensus statement. Methods: A bibliographic review of the existing scientific evidence and consensus was developed by the authors on the definition of fibrosis in the field of sport. Results: Our working group proposed the definition of fibrosis as an abnormal accumulation of extracellular matrix, usually with regards to an injury complication, showing various clinical findings affecting muscles, tendons, ligaments, articular capsules and nerves which, in turn, mars the recovery process, causing symptoms and finally leading to relapses. Conclusion: Fibrosis in sport may be considered as an abnormal accumulation of extracellular matrix, usually related to complications of an injury, showing a wide range of clinical symptomatology, affecting muscles, tendons, ligaments, articular capsules, and nerves.

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RATIONALE: Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied. OBJECTIVES: To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life. METHODS: We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed. RESULTS: Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (B = 0.417; p = 2.1e - 6, R2 = 0.156) and nocturnal CIS (B = 0.411; p = 7.7e - 6, R2 = 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life. CONCLUSIONS: The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended. TRIAL REGISTRATION: Clinical Trials ( https://clinicaltrials.gov ) under reference NCT04197037.

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OBJECTIVES: To determine the reasons of prescription, the characteristics of patients and factors that affected the outcome of critically ill patients treated with micafungin (MCF) during their stay in Spanish ICUs. MATERIAL AND METHODS: Observational, retrospective and multicenter study. Patients admitted to the ICU between March 2011 and October 2012 (20-month period) treated with MCF for any reason were included in the study. Severity of patients at the beginning of treatment was measured with the APACHE II, SOFA, Child-Pugh and MELD scores. Reasons for the use of MCF were classified as prophylaxis, preemptive treatment, empirical treatment and directed treatment. Continuous variables are expressed as mean and standard deviation or median, and categorical variables as percentages. A multivariate analysis was performed to identify variables related to intra-ICU mortality. RESULTS: The study population included 139 patients admitted to 19 Spanish ICUs, with a mean age of 57.3 (17.1) years, 89 (64%) men, with surgical (53.2%) and/or medical (44.6%) conditions, APACHE II score of 20.6 (7.7) and SOFA score of 8.4 (4.3), with 84.2% of patients requiring mechanical ventilation, 59% parenteral nutrition, 37.4% extrarenal depuration procedures and 37.4% treatment with steroids. MCF was indicated as empirical treatment of a proven infection in 51 (36.7%) cases, pre-emptive treatment in 50 (36%) especially as a result of the application of the Candida score (32 cases), directed treatment of fungal infection in 23 (16.5%) and as prophylactic treatment in 15 (10.8%) cases. In 108 (77%) cases, a daily dose of 100mg was administered, with a loading dose in only 9 cases (6.5%). The mean duration of treatment was 13.1 (13) days. A total of 59 (42.4%) patients died during their stay in the ICU and 16 after ICU discharge (hospital mortality 53.9%). Independent risk factors for intra-ICU mortality were the Child-Pugh score (OR 1.45, 95% CI 1.162-1.813; P=.001) and the MELD score (OR 1.05, 95% CI 1.011-1.099; P=.014). CONCLUSIONS: MCF is usually administered at a dose of 100mg/day, without loading dose and in 72.7% of cases as pre-emptive or empirical treatment. Factors that better predicted mortality were indicators of liver insufficiency at the time of starting treatment.

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Objetivos. Evaluar los efectos de 24 sesiones de ejercicio de fuerza (EF) progresivo, de intensidad moderada/alta sobre la capacidad funcional, la fuerza muscular y la composición corporal de un anciano con gonartrosis (GA) bilateral. Método. La capacidad funcional, la fuerza muscular y las variables antropométricas fueron medidas antes y después de 24 sesiones de entrenamiento. El paciente realizó el EF progresivo entre 8 y 12 repeticiones máximas, utilizando los principales grupos musculares de los miembros superiores e inferiores, 2 veces por semana durante 12 semanas. Resultados. Hubo una mejora en el test de sentarse y levantase (46,1%), en el sentar y alcanzar (33,3%), así como un aumento de la fuerza muscular en todos los ejercicios analizados y mejora de los índices antropométricos. Conclusión. Los resultados de este estudio indican que 24 sesiones de EF progresivo pueden ser eficaces en la mejora de índices antropométricos, la capacidad funcional y la fuerza muscular de un paciente anciano diagnosticado de GA bilateral (AU)

Objective. To evaluate the effects of 24 moderate-high intensity progressive Resistance Training (RT) on functional capacity, muscle strength and body composition in an elderly patient with gonarthrosis (GA) bilateral. Methods. Functional capacity, muscle strength and anthropometric variables were measured before and after 24 training sessions. The patient performed a 12-weeks progressive RT (2 times/week), between 8 and 12 repetitions maximum, using the major muscle groups of the upper and lower limbs. Results. There was an improvement in the sit-to-stand test (46,1%), in sit and reach test (33,3%), the muscle strength increased in all exercises analyzed and the anthropometric indices enhanced. Conclusion. The results of this study indicate that 24 sessions of progressive RT, can be effective in improving anthropometric indices, functional capacity and muscle strength of elderly patients diagnosed with GA bilateral (AU)

Objetivo: Avaliar os efeitos de 24 sessões de treinamento de força (TF) progressivo de intensidade moderada/alta sobre a capacidade funcional, força muscular e composição corporal de um idoso diagnosticado com gonartrose (GA) bilateral. Métodos: A capacidade funcional, força muscular e as variáveis antropométricas foram avaliadas antes e após 24 sessões de treinamento. O paciente realizou o TF progressivo entre 8-12 repetições máximas, utilizando os principais grupamentos musculares dos membros superiores e inferiores, duas vezes por semana, durante 12 semanas. Resultados: Ocorreu melhora no teste de sentar e levantar (46,1%), teste de sentar e alcançar (33,3%), assim como, os índices antropométricos e níveis de força aumentaram em todos os exercícios realizados. Conclusão: Os resultados deste estudo indicam que 24 sessões de TF progressivo podem ser eficazes na melhora dos índices antropométricos, capacidade funcional e força muscular de um paciente idoso diagnosticado com GA bilateral

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OBJECTIVE: To provide the first description in Spanish of the Lobenhoffer approach to treat fractures of the posteromedial region of the tibial plateau. MATERIAL AND METHODS: We report 14 clinical cases of patients with fractures of the posteromedial region of the tibia treated at our service using the Lobenhoffer approach. RESULTS: All patients were retrospectively assessed after a minimum follow-up period of two years. Complications and the knee status and function were assessed using the Knee Society System (KSS) score. Knee status results were good to excellent, while functional results were excellent to good in 8 patients, fair in 3 and poor in the 3 remaining ones. CONCLUSION: The Lobenhoffer approach represents and easy and reproducible posterior approach and has a low complication rate.

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Objetivo: Analizar y comparar la incidencia de asma en adolescentes y adultos de Huelva. Determinar los cambios (aparición, persistencia y remisión) de sibilancias, hiperreactividad bronquial (HB) y asma, así como esclarecer los posibles factores de riesgo de asma incidente. Metodología: Seguimiento de 9 años de la cohorte original tras el estudio transversal inicial. Se realizó una segunda evaluación de los 2 grupos analizados, 401 niños del Estudio de Enfermedades Respiratorias y 204 adultos del Estudio Europeo de Enfermedades Respiratorias. Ambos realizaron un cuestionario sobre síntomas respiratorios, una espirometría y una prueba de metacolina. Resultados: La incidencia anual acumulada de asma en los niños (15,69/1000 personas-año) fue tres veces superior a la de los adultos (4,76/1000 personas-año). En los niños hubo un 24,2% de apariciones y un 4,3% de remisiones de sibilancias en los últimos 12 meses. De esta forma, las apariciones superaban a las remisiones (p < 0.001). También se produjeron más apariciones que remisiones en HB (13,9% vs 5,4%;p = 0,02) y asma (9,3% vs 3%; p = 0,004). En los adultos se encontraron más apariciones que remisiones (15,7%vs6,9%;p= 0,011)de sibilancias e HB (10,1% vs3% ; p =0,017) no se hallaron cambios significativos en el seguimiento de asma. Los factores de riesgo más importantes relacionados con asma incidente fueron: tener sibilancias (RR: 8,12) y opresión torácica(RR: 9,17) al estar cerca de un animal. Conclusiones: La incidencia de asma en adolescentes es tres veces superior a la de los adulto (AU)

Objective: To analyse and to compare the incidence of asth main adolescents and adults of Huelva. To determine the changes (appearance, persistence and remission) of wheezing, bronchialhyper-responsiveness(BH) and asthma, as well as to clarify the potential risk factors for incidence of asthma. Methodology: Nine year follow-up of the original cohort after the initial cross-sectional study. A second evaluation was made of the 2 analysed groups, 401 children of the Respiratory Diseases Study and 204 adults of the European Respiratory Diseases Study. Both groups completed a questionnaire on respiratory symptoms, spirometry and methacholine challenge test. Results: The accumulated annual incidence of asthma in children(15.69/1000 persons / year) was three times higher than in adults (4.76/1000 persons / year). In children there were24.2% of occurrences and 4.3% of remissions of wheezing in the last 12 months. Thus, the occurrences exceeded remissions(p < 0.001). There were also more occurrences than remissions in BH (13.9% vs. 5.4%; p = 0.02) and asthma (9.3%vs. 3%; p = 0.004). In adults, there were more occurrences than remissions (15.7% vs. 6.9%; p= 0.011) of wheezing and BH (10.1% vs. 3%; p =0,017) with no significant changes found in the asthma follow-up. The most important risk factors associated with incident asthma were presence of wheezing (RR: 8.12) and thoracic oppression (RR: 9.17) when being near an animal. Conclusions: The incidence of asthma in adolescents is three times higher than in adults (AU)

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Solid organ transplantation is becoming increasingly more common in the treatment of end-stage organ failure. The advent of newer immunosuppressive protocols and refined surgical techniques has allowed therapy to become standard care. Infection is a major and frequently life-threatening complication after transplantation and the incidence of opportunistic fungal infections in organ transplant recipients ranges from 2%-50% depending on the type of organ transplanted. We present a case of rhinomaxillary form of mucormycosis infection after liver transplantation. The succession of multiple risk factors in a torpid postoperative period was a key factor in the development of this disease. Multidisciplinary management with an early diagnosis, aggressive surgery, and intravenous and topical antifungal therapy care were definitive for the eradication of infection. The goal of the present report was to show efficacious management including the association of topical treatment with amphotericin B complex lipid to standard therapy and the absence of side effects.

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The main objective of this study is to understand the differences in equilibrium control between normal subjects and those with Down syndrome. A total of 54 subjects participated voluntarily, divided into control group and Down syndrome group. The equilibrium of the subjects was tested under two conditions: bipedal support with eyes open and closed. The signals were analyzed in a time and frequency domain. The statistical parameters selected (i.e., RMS distance, mean velocity, mean frequency and sway area) to analyze the behavior of the center of pressures (CoP) are calculated employing the result of the combination of the time series data in both directions (i.e. resultant distance). In order to calculate the frequency bands produced by the displacements of the CoP, a Fast Fourier Transform of the data was performed. The group with Down syndrome showed poorer static equilibrium control than the control group in the time domain. In the frequency domain, we found differences between the groups in the distribution of energy in the frequency bands analyzed. In addition, we observed the existence of an interaction effect of the group and the condition tested (p<0.001). These findings show that in the absence of visual information, the control group increases the energy at low frequencies, while the group with Down syndrome decreases it. Additionally, the lower amount of energy observed in this band under the 'eyes closed' condition may serve to identify abnormalities in the functioning of the vestibular apparatus of individuals with Down syndrome and/or difficulties experienced by these individuals in extracting relevant information from this route.

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Objetivos: Conocer en los trabajadores de nuestro Hospital el número de exfumadores, no fumadores y fumadores activos, profundizando en las características del consumo de tabaco de estos últimos. Saber su predisposición al abandono y si precisarían de ayuda. Evaluar la opinión de los mismos con respecto al cumplimiento de la prohibición vigente del consumo de tabaco en centros sanitarios, el papel modélico del personal sanitario, si creen necesario realizar acciones para que no se fume en el hospital y si estarían dispuestos a colaborar con ellas. Material y métodos: Encuesta distribuida en los meses de julio y septiembre de 2004 a todos los trabajadores de las distintas categorías profesionales de nuestro centro hospitalario. Resultados: 411 encuestas válidas (20,30% participación). Se declaraban fumadores 25,9%, exfumadores 16% y nunca habían fumado 58,1%. De los fumadores 20,2% eran hombres y 79,8% mujeres, mediana de edad de inicio de 16 años. Los colectivos de mayor prevalencia de consumo fueron enfermería (37,2%) y auxiliares de clínica (24,4%). La mediana del test de Fagerström obtenida fue de 4. El 89,4% de los fumadores se encontraban en fase de contemplación y el 86,8% en fase de preparación. El 81% de los fumadores expresaba la necesidad de ayuda para lograr el abandono. El 91,2% consideraba importante el papel del profesional sanitario como ejemplo para el resto de la sociedad en cuanto al consumo del tabaco se refiere; 94,4% opinaba que en nuestro Centro se incumple la ley que actualmente regula el consumo de tabaco en los centros sanitarios; 96,3% creía que se debían iniciar acciones para evitar dicho consumo y 96% estaría dispuesto a colaborar con las mismas. Conclusiones: Menor prevalencia de fumadores que en la población general. Predominio femenino, sobre todo en el colectivo de enfermería y auxiliares. Alta predisposición a realizar un intento serio de abandono, aunque recibiendo ayuda. Importante conciencia del papel modélico que tenemos los sanitarios. Muy elevado porcentaje de incumplimiento de la prohibición de fumar, aunque también elevada creencia de que hay que cambiarlo y gran predisposición a colaborar con las nuevas medidas para lograr un hospital sin humos (AU)

Objectives: Discover the number of ex-smokers, non-smokers and active smokers in the workers of our hospital, thoroughly studying the characteristics of tobacco consumption of the latter. Know the predisposition to stop smoking and if they would require help. Evaluate their opinion in regards to complying with the current ban on smoking in health care sites, the model role of the health care personnel, if they consider it necessary to take actions to stop smoking in the hospital and if they are willing to collaborate with them. Material and methods: Survey distributed in the months of July and September 2004 to all the workers of the different professional categories of our hospital site. Results: 411 valid surveys (20.30% participation). A total of 25.9%declared they smoked, 16% ex-smokers and 58.1% that they had never smoked. Of the smokers, 20.2% were men and 79.8% women, mean onset age 16 years. The group having the greatest prevalence of consumption was nurses (37.2%) and clinical auxiliary workers (24.4%). Median obtained on the Fagerström test was 4. A total of 89.4% of the smokers were in the contemplation phase and 86.8% in the preparation phase. Eighty one percent of the smokers expressed the need for help to stop smoking and 91.2% considered the role of the health care professional important as an example for the rest of society in regards to smoking. A total of 94.4% considered that the law the currently regulates smoking in health care sites is not fulfilled in our site and 96.3% believed that actions should be initiated to avoid this consumption. A total of 96%were willing to collaborate with them. Conclusions: There is a lower prevalence of smokers than in the general population with female predominance, above all in the nursing and auxiliary worker group. High predisposition to make a serious attempt to stop smoking, although receiving help. Important awareness of the model role that the health care professionals have. Very high percentage of non-compliance of the ban on smoking, although also high belief that this must be changed and great predisposition to collaborate with the new measures to achieve a hospital without smoke (AU)

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OBJECTIVE: To evaluate response to pressure and flow triggering in an experimental model of the normal, obstructive and restrictive lung with six non-invasive mechanical ventilation units: Vintil+ (VP), Respironics STD20 (RR), Puritan Bennet 335 (PB), Quantum (QT), DP90 (DP) and Sullivan II ST (SV). METHOD: Analog signals of volume, pressure and flow from a lung simulator were recorded by a Mingograph 34 polygraph. Positive inspiratory pressure (PIP) was 12 cmH2O, respiratory rate was 17 cycles/min, end expiratory pressure (PEEP) was 4 cmH2O, and inspiratory effort (P0.1) was 4 cmH2O. Parameters calculated were negative trigger pressure, trigger time (or the flow wave delay in triggering), and the percentage of peak inspiratory flow at which a change to exhalation or cycle phase. RESULTS: The RR and PB units had the best trigger response with pressure triggering below -1 cmH2O and trigger times less than 100 ms. VP proved to have the poorest response. The cycle of the RR agreed most closely with the standard (5-25% of peak inspiratory flow), whereas change to exhalation occurred with the other units with zero flow (in all patterns with DP90, and in restrictive patterns with PB and VP) or greater than 50% of peak inspiratory flow (in all models with QT). Analysis of pressure curves showed great differences in slope, plateau and depressurization. CONCLUSIONS: The RR unit proved to have the most homogeneous behavior for all the phase parameters studied as being the ones that most influence a patient's adaptation to a ventilator.

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Primary pulmonary hypertension is a progressive disease. Most affected patients are young and middle-aged women. Etiology is unknown, although a familial and genetic factor is present in up to 6% of cases. Endothelial dysfunction and abnormalities in calcium channels of smooth muscle fibers are the present pathogenetics theories. Diagnostic tests try to exclude secondary causes of pulmonary hypertension and to evaluate its severity. Acute vasodilatory test is vital in the selection of treatment. Oral anticoagulation is indicated in all patients. Lung transplant is performed when medical treatment is unsuccessful. Atrial septostomy is an alternative and palliative treatment for selected cases. Chronic thromboembolic pulmonary hypertension is a special form of secondary pulmonary hypertension, clinically undistinguishable from primary primary hypertension, is of mandatory diagnosis because it can be cured with thromboembolectomy. Pulmonary embolism is common in hospitalised patients. The mortality rate for pulmonary embolism continues to be high: up to 30% in untreated patients. The accurate detection of pulmonary embolism remains difficult, as pulmonary embolism can accompany as well as mimic other cardiopulmonary illnesses. Non-invasive diagnostic tests have poor specificity and sensitivity. The D-dimer level and the spiral CT angiography have also been employed as new alternatives and important tools for precise diagnosis of suspected pulmonary embolism. The standard therapy of pulmonary embolism is intravenous heparin for 5 to 10 days in conjunction with oral anticoagulants posteriorly for 3 to 6 months. The incidence of deep venous thrombosis, pulmonary embolism and death due to pulmonary embolism, can be reduced significantly and shown clear benefits only by adoption of a prophylactic strategy with low-molecular-weight-heparins or dextrans in patients at risk.

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Objetivo: Evaluar experimentalmente la respuesta del trigger, de la presurización y del ciclado ante un modelo de pulmón normal, obstructivo y restrictivo de 6 equipos de ventilación mecánica no invasiva: Ventil + (VP), Respironics STD20 (RR), Puritan Bennett 335 (PB), Quantum (QT), DP90 (DP) y Sullivan II ST (SV). Método: Se utilizó un simulador pulmonar cuyas señales analógicas de volumen, presión y flujo eran registradas en un polígrafo Mingograph 34. Los datos se obtenían con una presión inspiratoria positiva (IPAP) de 12 cmH2O, una frecuencia respiratoria de 17 ciclos/min, una presión espiratoria final (EPAP) de 4 cmH2O y un esfuerzo inspiratorio equivalente a una P0,1 de 4 cmH2O. Se calculó la presión negativa de disparo, el retardo del mismo en la onda de flujo o tiempo de trigger y el flujo inspiratorio pico (FIpico) en el que se producía el cambio a espiración o punto de ciclado. Resultados: Los equipos con mejor sensibilidad de trigger fueron RR y PB que demostraron una presión de disparo inferior a -1 cmH2O y un tiempo de trigger menor de 100 ms, mientras que la peor respuesta se halló en VP. El ciclado más acorde con el estándar (5-25 por ciento del FIpico) se obtuvo con el respirador RR, mientras que en los demás ventiladores el paso a espiración se producía con flujo cero (DP90 en todos los patrones, y en PB y VP en los patrones restrictivos) o superior al 50 por ciento (en el caso de QT en todos los patrones). El análisis de las curvas de presión demostró diferencias importantes en la pendiente, meseta y despresurización. Conclusiones: El comportamiento más homogéneo en las variables de fases estudiadas, que son las que más influyen en la adaptación del paciente al ventilador, se evidenció en RR. (AU)

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