NPunto

17

Authors: Otero Somoano, Á

INTRODUCTION Musculoskeletal disorders (MSD) can include injuries and symptoms that affect any part of the body. They mainly affect the locomotor system, that meaning joints, muscles, tendons, ligaments, bones... MSDs are associated with a strong impact on society, rarely addressed, since it involves a huge use of health resources. In a study carried out by the National Commission for Safety and Health at Work, in Spain, this type of disorder was pointed out as the one that generates the highest rate of temporary disability (TI) in comparison with other diseases or ailments. On admittance to Rehabilitation Services for physiotherapy (because of MSD), a training plan must be carried out. This means therapeutic exercise the patient should carry out (self-treatment). The purpose of this program will be to determine the appropriate and most efficient physical activity according to the patient. The program should be adapted to different issues: the daily activities carried out by the patient before the illness; their work activity; situation of the injury; psychological situation of the patient regarding the acceptance of their own illness. The physiotherapist is be the person trained to properly develop the training plan, after making the timely assessment of the patient. Joints are the most important areas of connection of the locomotor system, allowing the mobility of the body. Shoulder joint is the junction between the humerus and the scapula (glenohumeral joint) together with the junction with the clavicle. It is formed by muscles and ligaments attached to both bones. The upper part of the scapula contains two formations called the acromion and the coracoid process. Between the humerus and the acromion is the subacromial space that contains a variety of tendons and muscles; this is a critical area in shoulder injuries. The shoulder is one of the joints with the greatest range of mobility in the human body (and possibly the most complex). Painful shoulder syndrome is a common musculoskeletal condition. It can occur due to intrinsic disorders of the shoulder (eg: caused by the anatomical structures of the shoulder) or extrinsic (also called referred pain), in which case there is no functional limitation. Definition should be: pain that is located in the shoulder region, unilateral or bilateral, and that appears with some movements of the arm. OBJECTIVES The main objective is to carry out a 6-month sampling of the most common referrals to the physiotherapy service in a Primary Care unit and to determine which MSDs are the most frequent. Secondary objective: create a training program to help restore health to these patients, based on exercises to regain joint range and strength. To do this, a bibliographic review of the most appropriate self-treatment exercises will be carried out for the lesions detected. METHODOLOGY For a 6-month period we perform random sequential sampling of patients between the ages of 18 and 65 referred to the unit. We determine which MSDs are the most common. With the results obtained, a training plan for the recovery was carried out for the patient. RESULTS Exhaustive review of the 523 patients referred was made. It was detected that the most common body areas affected by MSDs were the cervical area (cervicoarthrosis being the most common), the lumbar area (mechanical low back pain being the most common) and the shoulder joint (painful shoulder). CONCLUSION Identifying the most frequent MSDs in society can help to understand the need to take action in these areas, directing the work of the Primary Care physiotherapist towards timely and effective strategies that allow reducing the prevalence of these pathologies. This would reduce the duration and number of Temporary Disabilities (IT).

23

Authors: Ruiz Martínez, C

INTRODUCTION Musculoskeletal disorders (MSDs) in nursing staff. MSDs are a group of conditions that affect the muscles, tendons, ligaments, nerves and skeletal structures of the body, which can reduce a person´s functional ability. Nursing workers are particularly vulnerable to MSDs due to the physical and repetitive nature of their daily tasks, which can increase the risk of developing MSDs, especially if they are performed repetitively or under ergonomically unfavourable conditions. In addition, nurses also face a high emotional burden due to direct contact with patients and difficult situations, which can increase stress and the risk of developing MSDs. MATERIAL AND METHODS To conduct this literature review, a systematic search was performed in several databases, including PubMed, Scopus, CINAHL and Web of Science. The search was conducted using a combination of keywords and MeSH (Medical Subject Headings) terms. The following search terms were used: "musculoskeletal disorders", "nursing", "risk factors", "primary prevention" and "secondary prevention". In addition, reference lists of selected studies were reviewed to identify additional relevant studies published from 2018 to 2023 published in both English and Spanish. RESULTS The results evidence that musculoskeletal disorders (MSDs) are a common problem in nursing staff due to the physical and repetitive nature of their daily tasks. The prevalence of MSDs in nursing staff ranges from 50% to 90%. MSDs can have negative consequences on the quality of life, job satisfaction and productivity of nursing staff, which can affect the quality of patient care. Preventive and therapeutic strategies exist to prevent and treat MSDs in nursing staff, such as ergonomics training and education, implementing workplace safety policies and procedures, and making changes to the design of the work environment. Physiotherapy and occupational therapy are also effective in the treatment of MSDs in nursing staff. Female gender, older age and overweight are associated with a higher prevalence of MSDs in nurses, while nurses with higher levels of education and work experience are less likely to experience MSDs. Lack of time and resources for the prevention and treatment of MSDs in nursing staff is a common problem that needs to be addressed by employers and decision-makers in the health sector. CONCLUSION The prevention and treatment of musculoskeletal disorders (MSDs) in nursing staff is a major concern due to the physical nature of the work they perform. The implementation of safe and ergonomic work programmes and policies, education and training in MSD prevention and treatment, as well as an improved safety culture in the workplace, are important to address this problem. The literature review suggests that coordinated and collaborative action between employers, nursing workers, decision makers and other health professionals is required to achieve a safe and healthy work environment for nursing staff.

43

Authors: Antón Santos, B

INTRODUCTION Congenital muscular torticollis (CMT) is an idiopathic postural deformity of the head and neck, related to the unilateral contraction or retraction of the sternocleidomastoid muscle after an exaggerated elongation of the latter. When it is not treated or is treated late, we find the possibility of developing numerous sequelae with greater or lesser impact on the life and growth of children and adults. OBJETIVE The general objective of this work is to carry out an updated bibliographic review of everything we know about Congenital Muscular Torticollis with the latest studies and to group the different sequelae that can develop when muscular torticollis is not treated or resolved in time. MATERIAL AND METHODS This literature review performed a systematized search of articles in six online databases (Medline, SciELO, WOS, PEDRro and LILALCS). The following terms were used to carry out the search: Initially, “tortícolis”, “torticollis”, “tortícolis congénita” y “torticollis congenital”, and then further refine the search by adding other keywords to the search, “reflujo”, “reflux” “escoliosis”, “scoliosis”, “displasia cadera”, “hyp dysplasia”, “pelvis”, “pelvis”, “asimetría craneofacial”, “craniofacial asymmetry”, “plagiocefalia”, “plagiocephaly”, “mala oclusión”, “malocclusion”, “desarrollo psicomotor”, “psychomotor development”, “retraso neurodesarrollo”, “development delay”. I included all types of studies published since 2017 conducted in humans that discussed CCT and its long-term sequelae or comorbidities. RESULTS After searching different databases and other sources, 18 articles were selected for this review. These studies were chosen because, in addition to meeting the different selection criteria, they provided some information on the correlation that can be found between CCT and different anatomical or functional alterations over the years. CONCLUSIONS In general, there are few studies carried out since 2017 on the long-term impact of CCT. There are many previous articles on the relationship between CCT and certain alterations and dysfunctions that we observe during the growth of children and even in adults, and although they promote the need for verification and further research on the subject, I have not found a large number of articles in the last 5 years to be able to carry out this review with more objective data. Even so, I believe that with the data found and those already known, it is clearly evident that if CMD is not diagnosed and treated in time, it can trigger compensations that create other pathologies or syndromes that end up having considerable repercussions in pediatric and adult patients.

6

Authors: Martínez Pizarro, S., Sánchez Lozano, J

Introduction: Scoliosis is a disease that involves a curvature with lateral displacement of the patient´s spine. It affects 2%-3% of young people between 10 and 16 years of age. Standard treatment is based on observation and orthopedic material. However, in the most current studies, Schroth exercises have been proposed to correct the spine. The aim of this paper is to review the efficacy of Schroth´s exercises in adolescent patients with idiopathic scoliosis. Method: A bibliographic review is carried out following the PRISMA regulations. The PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS databases were consulted. The tool proposed by Cochrane was used for the assessment of the risk of bias and the quality of the evidence was assessed with the GRADE system. Results: Schroth´s exercises are effective in reducing the severity of the scoliosis curve, improving Cobb angles, thoracic trunk rotation angle, cosmetic trunk deformity, gibbosity, waist asymmetry , spinal mobility and quality of life. Conclusions: Schroth exercises improve postural balance, signs and symptoms of idiopathic scoliosis in adolescents.

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Authors: Lorente Navas, J

Myofascial pain syndrome of cervical origin is a pathology with a high prevalence in the general population. This pain syndrome is the result of the appearance of tense bands in the muscles, developing myofascial trigger points that cause the patient a cycle of intense, disabling, limiting and continuous pain during the activity of daily life. To address this ailment, invasive physiotherapy is emerging as one of the most widely used and studied therapeutic tools by researchers. However, despite the fact that the literature is increasingly revealing more about the origin, development and treatment of the disease, there is still no terminology or clear and common diagnostic criteria available to health professionals who are experts in the field. For this reason, treatments lose specificity and efficacy, generating high rates of pain persistence and recurrences. The objective of this development work has been to compile the most current available evidence on the approach to this pathology, explaining, on the one hand, everything related to the clinical course of the disease, and, on the other hand, developing the diagnostic criteria and the invasive physiotherapy treatment proposals on which healthcare professionals rely today.

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Authors: Andrés Fernández, G

Osteoarthritis of the knee (OA) is a chronic disease that affects the knee joint and surrounding structures. It is highlighted by the progressive deterioration of the cartilage that lines the articular surfaces. This disease can cause pain, stiffness, inflammation and limitation of movement and function. The treatment for knee osteoarthritis depends on the degree of involvement and the symptoms presented by the patient. The most common treatments for knee osteoarthritis include lifestyle adjustments, physical therapy, anti-inflammatory medications, intra-articular injections, and, in some cases, surgery. Lifestyle changes can help reduce the symptoms of knee osteoarthritis. These include a healthy diet, regular exercise, and avoiding excessive activity. Physiotherapy treatment for knee osteoarthritis is based on techniques to reduce pain, improve joint mobility and strengthen the knee muscles. These techniques include stretching exercises, physical therapy, muscle strengthening, pain-relieving massage, and manual therapy to improve mobility. In addition, physical therapy treatment may also include treatments such as electrotherapy, heat therapy, and ultrasound to reduce pain and improve joint mobility. Anti-inflammatory drugs help relieve the pain, inflammation, and discomfort associated with this pathology. These include NSAIDs (angiotensin-converting enzyme inhibitors) and steroids. Surgery may include cleaning the joint, removing damaged tissue, and replacing cartilage. In addition, a specific exercise program that is tailored to the individual needs of the patient is recommended. These exercises should be performed on a regular basis to help improve joint mobility and prevent disability. In general, treatment for knee osteoarthritis focuses on relieving symptoms and improving function. Prevention is the best way to treat this pathology. This includes practicing a healthy lifestyle, regular exercise, and proper knee care.

9

Authors: Redondo Castán, L.C., Porroche Urtiaga, C., Compaired Guio, A.B., Gimeno García L

The demand for assistance at the out-of-hospital level in the face of a person who presents a decrease or transient loss of the level of consciousness (PTC) is frequent in the general population. Thus, in the study by Sánchez et al., they estimate that between 3 and 4 people out of 10 will suffer an episode of PTC throughout their lives in adulthood and that 2 out of 10 young people will suffer at least one episode in adolescence (1). Transient loss of consciousness, particularly syncope, defined as transient, spontaneous loss of consciousness with rapid recovery without sequelae and due to global cerebral hypoperfusion, is usually trivial, but between 1-3% of this population will require hospital admission. For study and/or control of the event. This incidence implies that the nursing professional who attends a CTP process must know how to carry out a correct systematic nursing assessment to discriminate life-threatening situations and inform or request help from the emergency and/or emergency services (061/112) if necessary. Likewise, we will review the care quality indicators presented by the Spanish Society of Cardiology in the 2021 SEC-Primary syncope process (2). This work wants to offer a nursing assessment in CTP processes, carrying it out in a focused and systematic way through the 11 Functional Patterns of Marjory Gordon (MG) (3).

23

Authors: Menéndez Argüelles, M

Stupor and coma are a frecuent cause of consultation in emergencies. There are many elements that can cause coma, some of which are treatable, and that is why it is really useful to take them into account based on the dyagnosis to optimize the treatment. The terms lethargy, stupor and obtundation refer to states between coma and alertness, but it is better to describe the level of consciousness based on clinical scales such as GCS – Glasgow coma scale. It is relevant to the history to obtain the statements of the ones who witness the process. Information such as the possibility of a head trauma, the patient’s personal effects and prescriptions and also their medical history can be decisive. Coma is an emergency so appart from  the specific treatments based on the cause, the management should be prioritizing the ABCs- airway, breathing and circulation like in any other emergency. In the management, the priority is to distinguish structural and toxic-metabolic etiologies. The second ones usually have a progressive development, fluctuating course and abscence of focal signs. The abrupt appearance, deep and the presence of focal signs would suggest an structural cause. About the 70 % of the stupor and coma are caused by toxic and metabolic etiologies. There are many metabolic causes, such as glucose alterations (hypoglycemia and hyperglycemia),  calcium, sodium, oxygen.. Also, other patologies like liver failure and renal insufficiency, or specific diseases like porphyria and Wernicke encephalopathy might be a cause. Each one of these causes has its treatment peculiarities, which are important to be known in order to have a greater focus of the management of coma.

25

Authors: Peláez Herrero, N

Type 2 diabetes mellitus (DM2) is a disease that affects the metabolism of carbohydrates, lipids and proteins, is chronic and progressive that is accompanied by a multitude of manifestations that affect the main organs, especially the kidney, heart. Also affecting various tissues and organs other than those already mentioned. These alterations can be serious and even fatal. We can consider that DM 2 is becoming a public health epidemic worldwide, being related to microvascular and macrovascular complications that are associated with high cardiovascular morbidity and mortality. Both DM 2 and Heart Failure (HF) have a high prevalence among the population. This prevalence increases as the age of patients increases. Healthy lifestyle habits and adequate physical exercise can prevent the onset of T2DM. On the contrary, poor eating habits, sedentary lifestyle and obesity can be triggers of it. Once T2DM is diagnosed, first-line treatment is done with the oral antidiabetic drug, metformin, as long as it is indicated and tolerated by the patient. The objective is to investigate drugs that are able to adequately regulate blood glucose levels, but at the same time are capable of producing protective effects on organs that can be harmed, above all, that produce beneficial effects on the heart and metabolism in general. Therefore, in this work of bibliographic review we are going to study the inhibitors of the sodium-glucose cotransporter (iSGLT2), which will act at the level of the renal tubules preventing glucose from being reabsorbed and passing back into the blood, causing, in this way, an increase in urine glucose levels. All this will produce a significant improvement in blood glucose levels and as a consequence there will be weight loss, a reduction in blood pressure, among other benefits. The fact of these drugs to inhibit the reabsorption of glucose will produce a series of effects such as an increase in the formation of glycogen, an increase in the formation of ketone bodies, a caloric deficit that translates into weight loss and an increase in the sensitivity of cells to insulin. With respect to the cardioprotective effect, this is due to the fact that they produce hypotension, and a decrease in filling pressures. The great advantage of these drugs is that their action will not depend on the stage in which the DM2 is, since all these actions do not depend on the levels of insulin secreted by the pancreas. The action of the inhibitors of the sodium-glucose cotransporter SGLT2, at no time, will be related to the levels of the hormone insulin present in the patient, which is a great advantage, because we can use these drugs at any time of the disease. Likewise, they are able to reduce endothelial dysfunction, inflammation and oxidative stress, which significantly improves their cardiometabolic profile.  We are going to cite the studies and metanalysis that have been carried out until 2022, and we will see how the treatment in DM2 and Heart Failure (HF) is evolving, with these new active ingredients. Specifically, we will study the 4 active ingredients that are currently being marketed in Europe, namely dapagliflozin, canagliflozin, empagliflozin and ertugliflozin. However, the efficacy and safety of these active ingredients must be evaluated with daily clinical practice, since they are not exempt from adverse effects, which, in some cases, such as diabetic ketoacidosis (DKA), are more frequent than the studies analyzed say, in addition to being life-threatening. Many of these side effects require hospitalisation and patient monitoring. Therefore, we ask ourselves, is the use of ISGLT2 justified based on their efficacy/safety?

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Authors: Valdés Álvarez, M., González Molejón, J.A., García Álvarez, M.A., Iglesias Ruisánchez, S., González Bello, D

EP is the second most frequent disease in the West behind Alzheimer’s disease, it presents as a chronic, long-lasting, irreversible disease with a symptomatology that worsens over time. Although many studies today do not know the causes that triggers, it is postulated that the answer could be in genetic predisposition along with environmental factors.

22

Authors: Sumillera Diéguez, C.I

In this paper, we will conduct a bibliographic review on gender-based violence. As this phenomenon is very broad, we aim to focus mainly on the treatment of male aggressors. Therefore, we will give a brief review of what gender-based violence is, going through some of the most relevant theories about factors which cause it, and explanations about maintaining a violent relationship. We will touch lightly on the psychological consequences for the victims (both women and sons and daughters). All this will serve to put us in context and broadly address the possibilities of psychological treatment to male aggressors: the reason for the importance of this treatment, what types of therapy currently exist, difficulties in this type of therapy, necessary training of therapists... and other data that we consider to be of interest when working with this population.

25

Authors: Monzoncillo Benés, E

Terminal disease is one that is an advanced stage and therefore does not respond to treatments, so death is expected, in a short period of time. The advanced stage of a terminal patient fulfils the following characteristics: The disease is incurable and its progression is rapid It does not respond to any type of treatment. The prognosis of life, is less than 6 months, so there is a strong emotional impact on the patient, his family and health specialists given the proximity of death, causing an important physical suffering, as well as the loneliness and isolation of Patient. Cancer is a very common pathology to be seen in this terminal phase. So when choosing a case study for my master thesis, I chose a stage IV of lung cancer in the terminal four months after its diagnosis that did not respond to any type of treatment. To do so I make a plan of care where in addition to giving the importance that deserves the patient, I also center in the family, it is important to cite them when talking about this disease, they play a very important role in it. So descriptively, we will treat concepts related to palliative care, concepts of communication with the patient and his family and of course, the issue of mourning. Objective: Design a care plan aimed at the patient with terminal illness, adapting it to the psychological needs mainly, while other data that are important to know to reduce anxiety and pain and therefore to bring a better duel both them, as the primary caregiver, as the whole family itself. Material and methods: We carry out a bibliographical search of the last five years in different databases, using key words like terminal disease, phases of terminal disease, primary caregiver, resources, ways of coping with terminal illness, duel, Terminal patient psychology and how to treat a terminally ill. I also include important points of the disease, such as treatment, care of the mouth etc, that is, points that are important to remark in the terminally ill, and that their knowledge, will do both to him, as to his family, to have greater control of the disease and by Thus reduce her anxiety. Results: After the study performed on the terminal patient, the most important thing is to emphasize that the different activities carried out on this type of patients, should not be directed to cure, but to achieve pain relief and maximum autonomy until the time of Death, so that the health workers who form the team of palliative care, both nurses, as doctors, as psychologists, should consider the aforementioned as a goal, so for this, should be supported in a proper training of the own Patient and family with such basic concepts as the care of the mouth, or how to act in an urgency or at the time of mourning, knowledge of this type of information, will make both nurse and family, are more calm and not unencumber for not knowing Acting, in this way, will better address the problems that may appear. Discussion and conclusions: Integral care for the terminal patient is essential, but it is also important to communicate and train both the sick and the family. The fact that both understand what is happening and are properly formed to know how to solve any type of problem that may arise, provokes in the binomial a tranquility that helps you to better cope with the disease and what it implies. Having a slight idea of how to cope with the situation when digestive and respiratory symptoms appear, and simply when you have pain or a small wound in your mouth, makes your own autonomy, reduce the anxiety of both.

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Authors: Rodríguez Chacón, C., Jiménez Barragán, M., Fuentes Cantero, S

Cardiovascular diseases are one of the main causes of death, with atherosclerotic cardiovascular disease being the leading cause of death in the world. This requires knowledge of the pathophysiological mechanisms that produce it, as well as the risk factors associated with its development. This can allow both the prevention of the development of atherosclerosis and better control of the patient with established atherosclerotic cardiovascular disease. Knowledge of the individual cardiovascular risk presented by a person can be established on the basis of risk estimation tables, which study various factors such as age, sex, smoking habit, systolic blood pressure and total cholesterol. Finally, the use of cardiovascular risk markers (serum lipids, triglycerides, apolipoproteins, lipoprotein A, C-reactive protein, homocysteine, nitric oxide or asymmetric dimethylarginine) is of vital importance for the management of these patients, which allow to identify individuals or population at risk for these pathologies, since they are associated with an increase in the probability of suffering cardiovascular diseases.

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Authors: Gómez Camarón, M.B

Deep Vein Thrombosis (DVT) is a very common and fatal condition and because its clinical diagnosis is impractical, in many cases, the condition is often diagnosed with a delay. In the last year, the number of thrombosis cases has seen an increase due to its connection to the coronavirus infection. This is the most important and serious consequence of this condition. This work shows that, with the deep vein thrombosis condition, prevention factors or early treatment is vital, since it can affect anyone and a delay in diagnosis or treatment can lead to cause disability and even death. One of our main objectives is to increase awareness regarding deep vein thrombosis and the link this condition has with coronavirus 19. We must bear in mind that deep vein thrombosis is a preventable condition with an early diagnosis and its corresponding treatment. With regards to its relationship to the cardiovascular system, in patients with COVID 19, cardiovascular complications are highly prevalent in 30% of the hospitalised patients. These complications will require long term monitoring.

26

Authors: Martínez Garrido, D

The heart is a small muscular organ located in the lower part of the anterior compartment of the mediastinum. It consists of three layers of tissue and is internally subdivided into four chambers, which are connected by heart valves. The heart acts as a pump, since it is responsible for pumping blood throughout the body, which is possible thanks to the cardiac cycle, a coordinated succession of contraction and ratio movements, i.e., systole and diastole. The human heart develops between the third and sixth week of intrauterine development, starting in the cardiogenic plate of the embryonic mesoderm, which after multiple modifications gives rise to the definitive heart. Following the changes in the baby´s cardiovascular system after birth, the morphological and structural changes of the heart throughout a person´s life are minimal, until the physiological ageing, which again triggers a series of modifications, especially at a functional level, that increase the risk of pathologies. The most frequent of these is heart failure, a disease of progressive evolution, where nursing plays an important role in person’s health education.