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Serrano González J, Román García de León L, Galindo Jara P, Lucena de la Poza JL, Sánchez Movilla A, Colao García L, García Schiever JG, Varillas Delgado D. Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study. Rev Esp Enferm Dig 2024; 116:140-147. [PMID: 37929981 DOI: 10.17235/reed.2023.9737/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. METHODS an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018. RESULTS three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group. CONCLUSIONS in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.
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García Torrejon MC, Heras de la Calle G, Martin Delgado MC, Franco Garrobo N, Gordo Vidal F, Varillas Delgado D, Caballero Martínez F, Álvarez Montero S. Spirituality in Critical Care: An Observational Study of the Perceptions of Professionals, Patients and Families, in Spain and Latin America. J Relig Health 2023; 62:2391-2411. [PMID: 36729211 DOI: 10.1007/s10943-023-01746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
This research aims to describe the perspectives of health care professionals, patients, and family members regarding spiritual care options in intensive care units (ICUs). Participants were recruited consecutively from January to August 2019, during which time data collection was conducted. A total of 1211 Spanish-language questionnaires were collected from 41 ICUs in Spain and Latin America. Approximately 655 participants worked as ICU professionals (74.5% of these participants were women, and 47.5% were nurses). Additionally, 340 questionnaires were sent to patients' families, and patients completed 216 questionnaires; 59.7% of these participants were men, and their mean age was 59.4 years. Most (69.7%) of the critical care professionals considered this type of care to be a part of their profession, 50.1% did not feel competent to provide this type of care, and 83.4% felt that training in this area was necessary. Most families (71.7%) and patients (60.2%) felt that spiritual suffering occurred during their stay in the ICU. The results of this study suggest a perceived deficit in spiritual care in ICUs.
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Affiliation(s)
- María Carmen García Torrejon
- Intensive Care Unit, Central Defence Hospital "Gomez Ulla", Glorieta del Ejército s/n, 28047, Madrid, Spain.
- Universidad Francisco de Vitoria, Madrid, Spain.
- International Research Project for the Humanisation of Intensive Care Units (HU-CI Project), Madrid, Spain.
- Spanish Society of Intensive Medicine (SEMICYUC), Madrid, Spain.
| | - Gabriel Heras de la Calle
- Universidad Francisco de Vitoria, Madrid, Spain
- International Research Project for the Humanisation of Intensive Care Units (HU-CI Project), Madrid, Spain
- Spanish Society of Intensive Medicine (SEMICYUC), Madrid, Spain
- Intensive Care Unit, Comarcal Santa Ana de Motril Hospital, Granada, Spain
- Pan American and Iberian Federation of Critical Medicine and Intensive Care (FEPIMCTI), Madrid, Spain
| | - María Cruz Martin Delgado
- Universidad Francisco de Vitoria, Madrid, Spain
- International Research Project for the Humanisation of Intensive Care Units (HU-CI Project), Madrid, Spain
- Spanish Society of Intensive Medicine (SEMICYUC), Madrid, Spain
- Intensive Care Unit, Doce de Octubre University Hospital, Madrid, Spain
- Pan American and Iberian Federation of Critical Medicine and Intensive Care (FEPIMCTI), Madrid, Spain
| | - Nieves Franco Garrobo
- Universidad Francisco de Vitoria, Madrid, Spain
- Spanish Society of Intensive Medicine (SEMICYUC), Madrid, Spain
- Intensive Care Unit, Móstoles University Hospital, Madrid, Spain
| | - Federico Gordo Vidal
- Universidad Francisco de Vitoria, Madrid, Spain
- Spanish Society of Intensive Medicine (SEMICYUC), Madrid, Spain
- Intensive Care Unit, Henares University Hospital, Madrid, Spain
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Calvo Espino P, Sánchez Movilla A, Alonso Sebastian I, García Schiever J, Varillas Delgado D, Sánchez Turrión V, López Monclús J. Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy. Acta Chir Belg 2022; 122:41-47. [PMID: 33176613 DOI: 10.1080/00015458.2020.1846941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Stoma site incisional hernias after ileostomy closure are complex hernias that can be associated with abdominal pain, discomfort, and a diminished quality of life. The aim of this study was to determine the incidence of incisional hernia (IH) following temporary ileostomy reversal in patients undergoing colorectal surgery, and the risk factors associated with its development. METHODS This was a prospective, single-centre, cohort study of patients undergoing ileostomy reversal between January 2010 and December 2016. Comorbidities, operative characteristics, comparison between early and late ileostomy closure and postoperative complications were analysed. RESULTS A total of 202 consecutive patients were prospectively evaluated (median follow-up 46 months; range: 12-109). Stoma site incisional hernia occurred in 23% of patients (n = 47), diagnosed by physical examination or imaging tests. The reasons for the primary surgery were colorectal cancer (n = 141, 69.8%), inflammatory bowel disease (n = 14, 6.9%), emergency surgery (n = 35, 17.3%), and other conditions (n = 12, 5.9%). Secondary outcomes: a statistically significant risk factors for developing an IH was obesity (higher BMI) (OR 1.15, 95% CI: 1.05-1.26) p = .003). CONCLUSIONS 23% of patients developed surgical site IH, a higher BMI being the only risk factor found to be statistically significant in the development of an incisional hernia.
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Affiliation(s)
| | | | | | | | | | - Víctor Sánchez Turrión
- Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain
- Universidad Autonoma de Madrid, Madrid, Spain
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Lobo-Valbuena B, García-Arias M, Pérez RB, Delgado DV, Gordo F. [Characteristics of critical patients with COVID-19 in a Spanish second-level hospital]. Med Intensiva 2021; 45:56-58. [PMID: 33160704 PMCID: PMC7831452 DOI: 10.1016/j.medin.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023]
Affiliation(s)
- B Lobo-Valbuena
- Intensivista - Unidad de Cuidados Intensivos del Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - Mª García-Arias
- Supervisora de Enfermería de la Unidad de Cuidados Intensivos del Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R B Pérez
- Anestesista - Servicio de Anestesia del Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - D V Delgado
- Responsable de la Unidad de Apoyo a la Investigación. Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - F Gordo
- Jefe de Servicio de la Unidad de Cuidados Intensivos del Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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Varillas Delgado D, Tellería Orriols JJ, Monge Martín D, Del Coso J. Genotype scores in energy and iron-metabolising genes are higher in elite endurance athletes than in nonathlete controls. Appl Physiol Nutr Metab 2020; 45:1225-1231. [PMID: 32379996 DOI: 10.1139/apnm-2020-0174] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Information about the association of energy and iron-metabolising genes with endurance performance is scarce. The objective of this investigation was to compare the frequencies of polymorphic variations of genes involved in energy generation and iron metabolism in elite endurance athletes versus nonathlete controls. Genotype frequencies in 123 male elite endurance athletes (75 professional road cyclists and 48 elite endurance runners) and 122 male nonathlete participants were compared by assessing 4 genetic polymorphisms: AMPD1 c.34C/T (rs17602729), PPARGC1A c.1444G/A (rs8192678) HFEH63D c.187C/G (rs1799945) and HFEC282Y c.845G/A (rs1800562). A weighted genotype score (w-TGS; from 0 to 100 arbitrary units (a.u.)) was calculated by assigning a corresponding weight to each polymorphism. In the nonathlete population, the mean w-TGS value was lower (39.962 ± 14.654 a.u.) than in the group of elite endurance athletes (53.344 ± 17.053 a.u). The binary logistic regression analysis showed that participants with a w-TGS > 38.975 a.u had an odds ratio of 1.481 (95% confidence interval: 1.244-1.762; p < 0.001) for achieving elite athlete status. The genotypic distribution of polymorphic variations involved in energy generation and iron metabolism was different in elite endurance athletes vs. controls. Thus, an optimal genetic profile in these genes might contribute to physical endurance in athlete status. Novelty Genetic profile in energy generation and iron-metabolising genes in elite endurance athletes is different than that of nonathletes. There is an implication of an "optimal" genetic profile in the selected genes favouring endurance sporting performance.
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Affiliation(s)
- David Varillas Delgado
- Universidad Francisco de Vitoria, Faculty of Medicine, Research Unit, Pozuelo de Alarcón, Madrid 28223, Spain
| | | | - Diana Monge Martín
- Universidad Francisco de Vitoria, Faculty of Medicine, Pozuelo de Alarcón, Madrid 28223, Spain
| | - Juan Del Coso
- Rey Juan Carlos University, Centre for Sport Studies, Fuenlabrada, Madrid 28933, Spain
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Quesada JMA, Lloves JM, Delgado DV. Ocular chemical burns in the workplace: Epidemiological characteristics. Burns 2019; 46:1212-1218. [PMID: 31791857 DOI: 10.1016/j.burns.2019.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiological studies focusing on occupational pathologies can be an important medium through which to bring about change with respect to workplace accidents, both in terms of prevention planning and management as well as the appropriate care following an accident. Ocular chemical burns benefit from urgent attention as, if not treated early and appropriately, the tissue of the eye and its functionality can be seriously compromised. The objective of this study was to collate epidemiological data on workplace ocular chemical burns which could in turn serve to identify key action points in terms of occupational health. METHODS Cohort study with 604 cases of chemical burns to the eye occurring in the workplace between 2014 and 2015. Criteria inclusion were diagnosis of chemical burn, patient seen at the medical centre of the mutual society, workplace acquired ophthalmic pathology leading to the issuing of a sickness certificate. No exclusion criteria were defined. RESULTS Ocular chemical burns were the second most common workplace eye injury (12.68%) behind foreign bodies in the eye (43.42%). Men accounted for 68.54% of cases of ocular chemical burns. In around 75% of cases, sickness certification was for less than 7 days, although 6 patients suffered permanent disability. The occupational sector which was most affected particularly the industry service industry. The economic costs with these workplace injuries were extracted. CONCLUSIONS Appropriate early medical assistance is essential. The production and distribution of clinical guides for health care workers could optimise first line assistance and mitigate possible training deficiencies.
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Affiliation(s)
- Jesús Moreno-Arrones Quesada
- Care Centre FREMAP, Oviedo, Spain; University Institute Fernández Vega. Ophthalmologic Research Foundation, Oviedo University, Spain.
| | - Jesús Merayo Lloves
- University Institute Fernández Vega. Ophthalmologic Research Foundation, Oviedo University, Spain.
| | - David Varillas Delgado
- Universidad Francisco de Vitoria, Faculty of Medicine, Pozuelo de Alarcón, Madrid, Spain.
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Sanchez-Redondo J, Espinosa G, Varillas Delgado D, Cervera R. Recurrent Thrombosis With Direct Oral Anticoagulants in Antiphospholipid Syndrome: A Systematic Literature Review and Meta-analysis. Clin Ther 2019; 41:1839-1862. [DOI: 10.1016/j.clinthera.2019.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/04/2019] [Accepted: 06/25/2019] [Indexed: 01/30/2023]
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Sutil Blanco Á, Bernaldo de Quirós Ramos S, Varillas Delgado D, García de Lucas F. Factores de riesgo y síndrome del túnel carpiano en el entorno laboral. Rev Iberoam Cir Mano 2018. [DOI: 10.1055/s-0038-1642596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Introducción Las neuropatías compresivas son las patologías neurológicas periféricas más frecuentes del miembro superior, suponiendo una de las principales causas de pérdida de días laborales. El síndrome del túnel del carpo (STC), es la más frecuente, y se produce por un atrapamiento del nervio mediano a su paso por el túnel carpiano resultando en un daño de tipo isquémico y mecánico. El objetivo de este estudio, fue investigar la relación causal entre la exposición a distintos factores de riesgo laborales y el STC en nuestro medio.
Material y Método Estudio descriptivo, observacional de casos-control restrospectivo. Doscientos veinte pacientes fueron diagnosticados con STC en el área de influencia de nuestro centro hospitalario. Se efectuó tratamiento quirúrgico en pacientes con manifestaciones clínico-electroneurofisiológicas de intensidad moderada-severa y falta de respuesta a medidas conservadoras.
Resultados Noventa y un pacientes fueron hombres (41,4%) y 129 mujeres (58,6%), todos en edad laboral, con una edad media de 45,26 años. El 85% presentaban alta repetición de movimientos de la muñeca. La mayoría presentaba afectada la extremidad dominante. Fueron intervenidos mediante descompresión quirúrgica 191 pacientes y 29 se trataron con medidas conservadoras. Se estudió la prevalencia del STC según los distintos gremios de trabajadores y factores de riesgo.
Conclusión Existe un mayor riesgo en profesiones con elevada repetición de movimientos de muñeca, de padecer STC con respecto a las profesiones que tienen baja repetición. La afectación de la mano no dominante tiene un riesgo menor que la mano dominante o la bilateral. El sexo femenino, obesidad, diabetes, artritis reumatoide e hiperuricemia, presentan mayor riesgo de STC, aunque no estadísticamente significativo. Como conclusión, existen determinadas profesiones que pueden aumentar el riesgo de padecer este síndrome, así como patologías endocrinas. Sin embargo, no se puede asumir que exista una relación causal suficiente para desencadenarlo.
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Affiliation(s)
- Ángel Sutil Blanco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP, Majadahonda, Madrid, España
| | | | - David Varillas Delgado
- Servicios Auxiliares, VEMESA, Madrid, España
- Facultad de Ciencias de la Salud, Unidad de Apoyo a la Investigación, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
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Abad Morenilla J, Sutil Blanco Á, Varillas Delgado D, García de Lucas F. Reparación del tendón extensor pollicis longus, mediante la técnica del lazo con el extensor pollicis brevis. Rev Iberoam Cir Mano 2018. [DOI: 10.1055/s-0038-1639512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Introducción Se presenta una alternativa quirúrgica a las técnicas convencionales para reparación de lesiones por herida o por mecanismo cerrado del tendón EPL, denominada lazo transfixiante y contínuo; el cual emplea el tendón de anclaje motor procedente del músculo EPB (Extensor Pollicis Brevis). El objetivo fundamental del estudio fue explicar el desarrollo de esa técnica y los resultados satisfactorios que muestra en la reparación de las lesiones completas del EPL.
Material y método Se describe un nuevo nudo, conocido como lazo transfixiante y continuo, el cual emplea el tendón de anclaje motor procedente del músculo EPB (Extensor Pollicis Brevis), uniendo el tendón EPL lesionado con el tendón EPB, envolviendo a éste, sin desinsertar la unidad motora del EPB, recuperando con ello la función extensora del primer dedo de la mano. Se seleccionó una serie de 10 casos de rotura del EPL reparados con esa técnica, en contexto de accidente laboral. Se tomaron como variables; edad, profesión, sexo, lateralidad, dominancia, mecanismo lesional, momento de la intervención y presencia de lesiones asociadas. Seis de los casos se produjeron por mecanismo lesional cerrado (60%), y los 4 casos restantes mediante herida (40%).
Resultados. Al finalizar el proceso, 9 pacientes presentaron como resultado curado (90%), mientras que sólo 1 de ellos resultado baremo (10%). No se observaron diferencias entre la extremidad sana y la extremidad operada en movilidad y en cuanto a resultados funcionales mediante tres mediciones; prensión, pinza terminoterminal y pinza lateral.
Discusión el lazo continuo transfixiante para la reparación de lesiones del tendón EPL empleando el tendón EPB es un procedimiento que genera un rango funcional efectivo. Aporta unos resultados satisfactorios, en cuanto a la funcionalidad objetivada a través de test biomecánicos, alcanzando adecuada tasa de reincorporación laboral.
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Affiliation(s)
- José Abad Morenilla
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP, Majadahonda, Madrid, España
| | - Ángel Sutil Blanco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital FREMAP, Majadahonda, Madrid, España
| | - David Varillas Delgado
- Servicios Auxiliares VEMESA, Unidad de Investigación, Hospital FREMAP, Majadahonda, Madrid, España
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