NPunto

24

Authors: Salvador Coscujuela, S

Dementias are syndromes that occur with cognitive impairment in several domains, which usually interferes significantly with the performance and normal functioning of people who suffer from them. This affects family members who will be exposed to significant physical, social, emotional and financial costs during the disease. Patients and caregivers suffer significant losses. The death of the patient is the last, but not the only loss that occurs in this context. Given the large number of losses that occur during these processes, it is of special relevance to know how the grieving process that patients and family members undergo is. Grief is defined as the psychological reaction that occurs after the loss of someone or something significant. It is a normal, natural and non-pathological process. The objective of the present work is to review the literature and the main studies that have been published about grief in dementias. To achieve this objective, a bibliographic search has been carried out in the main databases in order to find all those works that explore the theme of grief, both from the point of view of caregivers and the patients themselves and that refer to both anticipated grief and grief after death. The results of the bibliographic search show that many works focus on some particular aspects or moments of grief. For this reason, the present work has attempted to integrate the main findings and to present grief as a broad and global phenomenon that is present continuously after diagnosis. Studying grief in dementias is essential as it contributes to normalizing natural reactions to losses and makes it possible to explain some symptoms (depressive or anxious, for example) without the need to use a diagnosis of a mental health pathology. In addition to exploring grief, this work will provide alternatives for its evaluation and psychotherapeutic interventions aimed at giving emotional support to the main agents involved.

28

Authors: Sierra Tendero, N

Alzheimer´s disease is a neurodegenerative, chronic, progressive and incurable disease. It is the most common type of dementia today. The moment a person and their family are diagnosed with Alzheimer´s, their life takes a 180º turn. The most effective intervention is made up of pharmacological and non-pharmacological treatment. Although this intervention will not produce a recovery, it will treat the person´s symptoms, which will positively influence their quality of life. Among the non-pharmacological therapies is Occupational Therapy. The main objective of this is for the individual to achieve the highest degree of independence and quality of life through occupation. The occupational therapist will work holistically, intervening in the cognitive, physical and social sphere. The intervention at home will be based mainly on retraining of daily life activities, home adaptation, a program of cognitive stimulation, psychomotor skills and a leisure and free time program. This treatment will not cure or stop the progression of the disease, but it will improve the quality of life of the person and their main caregiver.

36

Authors: López Trueba, M.M

IAA (Animal-assisted interventions) are the basis of TAA (2), understood as interventions in which an animal is incorporated and used as part of the treatment, as a therapeutic resource, with the straight objective of promoting the improvement in physical, social, emotional and cognitive functions of the user, with the dog (or other animal) as a motivating element. They must always be leaded by a multidisciplinary health professionals team. It also can be defined as an innovative therapeutic process in which the animal is the bond, the bridge, the motivator ... of actions, gestures and emotions that conduce healing or significant improvement processes in people. These projects have the ability to inspire and motivate people to undertake constructive activities which they would not have done otherwise. There are more and more studies that support that therapy as a science and its effectiveness (3). According to Tucker (4), TAA (Animal Assisted Therapy) is a direct intervention with pre-designed objectives for situations of functional dependence, psychiatric or behavioral disorders, where an animal that meets specific criteria participates, as an essential part of the treatment. It is carried out in a wide variety of settings, individually or in groups, using different animals. The presence of a professional who master the animal is required, join a team of health professionals. The whole process must be previously designed and subsequently evaluated. In Spain this therapy is called Companion Animal Assisted Therapy (TAAC). In these interventions (5), the fundamental element is the dog (or other animals) since it is a motivating and stimulating element in itself, a fact that contributed to the development of TAA until its arrival in Europe. James A. Serpell, Director of the Center for the Interaction of Animals and Society at the University of Pennsylvania, at the opening lecture of the VII Congress "Companion Animals, Source of Health," by Affinity, noted that there was a close relationship between the increasing companion animals in households and the changes that are taking place in Western societies. The fact that more and more people are living alone, as well as that there is a greater number of single-parent families and that socialization is reduced due to the lack of spare time available, has favored, according to Serpell, the entrance of animals at home, counteracting with his affection and unconditional love the lack of emotional ties that people are currently experiencing. For this reason, more and more research are being carried out in this field; as well as the applications of TAP (Dog Assisted Therapy) in public institutions such as prisons, schools, hospitals and nursing homes.

7

Authors: Serrano Rosúa, C

This is a clinical case that refers to complex wounds and the management of these cases. She is a 68-year-old woman who has a superficial trophic lesion on the distal lateral outer face of the lower left extremity (near the malleolus) since a month and a half ago when she appeared and consulted her CAP doctor. Due to a poor diagnosis initially made at the time of the onset of her ulcer or due to a poorly suited treatment pattern for the type of wound, the patient presents a poor evolution of her treated lesion from the beginning to the primary care level. Due to the poor evolution of the ulcer is decided its transfer to hospital level. After being revalued by a team of experts in complex wounds, a correct diagnosis of your ulcer is made and a new treatment schedule adapted to your needs and characteristics of your wound at that time is applied. Our patient is diagnosed with a hypertensive Martorell ulcer. Probably related to its history of poorly controlled hypertension of years of evolution and the type of ulcer it presents. For this reason the need for a team of professionals trained in complex wounds and specialized in cures. Hence the importance of making a correct and early diagnosis to be able to adapt the subsequent treatment and avoid complications in the patient’s health, higher costs in healthcare, greater results in cures...

22

Authors: Álvarez Muñiz, N

Diabetes Mellitus is a chronic disease characterized by chronic hyperglycemia. In this disease lifestyle is very important, so bad habits such as sedentarism, poor eating habit or obesity favor the appearance of this or the development of complications. One of the most important complications of diabetes and, in turn, of peripheral arterial disease and neuropathy that it produces, is diabetic foot. Diabetic foot consists of ulceration, infection, or gangrene in the foot. The first step in the treatment of diabetic foot is to treat the cause for which it occurs, as is the case with revascularization when it is caused by peripheral arterial disease. Although initially this lesion is treated in primary care, it may need to be referred to other more specialized services and end with serious consequences such as loss of the limb. The consequences of the development of diabetic foot can be devastating, for this reason, it is important to make good prevention. It is vital to have a good health education for both diabetes disease and foot self-care in these patients.

23

Authors: Morilla Martín, A

Introduction and justification: Diabetes includes pathologies due to metabolic disorders that have in common hyperglycemia. The International Diabetes Federation, in 2019, indicates that 463 million adults had diabetes, and the deaths were 4.2 million. The Human Genome Project identified polymorphisms that can determine the genotype and phenotype, and therefore the probability of suffering from a certain disease. Objectives: To examine the effect of possible interactions between diet and genetics on glucose homeostasis, insulin resistance and risk of type 2 diabetes mellitus (DM2). Methodology: A review of the last 10 years at Pubmed is carried out using an electronic search strategy, after which articles are screened according to previously defined inclusion and exclusion criteria. The search formula used in the Pubmed database is: "(gene OR SNP OR polymorphism) AND interaction AND (nutrient OR diet OR fat OR carbohydrate OR protein) AND (type 2 diabetes OR insulin resistance OR glucose OR insulin OR HOMA-IR OR HOMA beta OR HbA1C)". Results: After the identification, screening and suitability phases, 25 articles were included in the literature review. Lipids interact with genes related to the metabolism of fatty acids producing effects on DM2, whereas the interaction observed with carbohydrates (HC), are related to the synthesis and regulation of insulin. In the study of gene-nutrient interactions with effect on insulin response (IR), genes have very different functions and the results obtained are very diverse. Conclusion: Different dietary nutrients such as lipids, HC, proteins, fiber and zinc, modify the relationship with TCF7L2, PPAR-γ, ACE, APOA2, SLC30A8, IRS1, ACC2, PPM1K, ELOVL6, PIK3CA-KCNMB3, IRS1, PLIN, S100A9, DHCR7, LPL ADIPOQ and FTO genes with the risk of DM2, insulin resistance or glucose homeostasis markers.

2

Authors: Lozano Gómez, H

INTRODUCTION: Currently, the research and development of new chemotherapeutic drugs has provided an improvement in the results in terms of their survival in oncological diseases. More and more patients are receiving these drugs and the new adverse effects are still unknown. RESULTS: Patient diagnosed with breast neoplasia in current treatment with chemo therapy and immunotherapy with atezolizumab and abraxane. Admitted for respiratory failure, with negative nasopharyngeal PCR-COVID-19, and perihilar alveolar opacities on the chest X-ray. Infectious etiology was ruled out so it was diagnosed along with the remaining systemic symptoms of a side effect of atezolizumab. In conjunction with oncology, immunosuppressive treatment was decided with mycophenolate mofetil and the evolution was good. CONCLUSIONS: Severe pneumonitis after atezolizumab is one of the side effects described, although fortunately rare, so its diagnosis is sometimes difficult assuming from the beginning an infectious etiology in a depressed patient

17

Authors: Castaño Espejo, A.C

Introduction: Myofascial pain syndrome (MPS) at the lumbar location is one of the most incident pathologies, with an estimated 85% of citizens of developed countries will experience this pain at some time in their life. MPS is a non-inflammatory disorder and manifests clinically as a chronic severe pain. There is no effective therapy against myofascial pain. Nowadays, non-invasive techniques are being used, among which the dry needling stands out for its encouraging results, but its scientific evidence is scarce. The objective of the present work was to determine the therapeutic effectiveness of dry needling to relieve pain in patients with lumbar MPS. Methodology: a systematic review has been designed, whose strategy for looking studies was based on electronic databases (Pubmed and PEDro), the use of keywords, the establishment of limits and criteria for the selection of studies, and evaluation of the quality studies (PEDro scale). Results: six studies were included, with an average methodological quality of 7.6. Dry needling decreased pain intensity, pressure pain threshold, sensitivity and disability of patients with myofascial low back pain. The needles of greater caliber (0.9 mm) were more effective, and if this technique is complemented with education in neuroscience it will be more effective to decrease kinesophobia. Furthermore, it was observed that the efficacy of dry needling was similar to that obtained with pharmacotherapy. Conclusions: dry needling is an effective non-invasive technique to reduce pain in patients with lumbar MPS.

21

Authors: Mediavilla Álvarez, E

Systemic lupus erythematosus is a complex chronic autoimmune disease and whose main symptoms are manifested with arthritis and joint pain, fatigue, erythema malar, oral ulcers, photosensitivity, serositis, osteoporosis, renal disorders, blood immunological. With advances in medicine and treatments this disease is considered chronic but not fatal as such, although it is true that the severity will depend on the involvement and sensitivity of the patient to the disease. In this work the disease and its characteristics will be defined, we will identify the various symptoms and will thoroughly treat the area of treatment of the disease clinic, with special emphasis on joint pain and the recommendations that the patient with systemic lupus erythematosus should follow in order to have an acceptable quality of life that allows him to lead a normal life.

13

Authors: Fernández Cadenas, Ángeles

Background: Respiratory physiotherapy techniques play a fundamental role in mucociliary clearance in cystic fibrosis (CF), but it has not yet been possible to demonstrate superiority of one technique over another. The objective of this study is to know the short-term effects of drainage of bronchial secretions using the autologous drainage technique (AD), a technique preferred by patients, with lung function tests (PFR) and measurement of the pulmonary clearance index (LCI) using the technique of washing nitrogen with multiple breaths (N2MBW), in patients with clinically stable cystic fibrosis. Methods: Nine subjects have been studied and have been measured SVC, FEV1, FVC, FEF25-75, FRC and LCI before and after a 30-minute AD session. Results: No significant differences were found in ICD, only one subject improved significantly, i.e., the ICD decreased by 1.8, and three other subjects improved with a decrease of less than 1 point, but we did find a slight significant decrease in CRF of 200 ml in the total sample (p=0.032) and an increase in SVC of 2.55 2.06 %, with a value of p=0.03. No significant improvement differences have been found in PFR, nor have significant correlations. Conclusions: A 30-minute session of AD has not generated significant changes in ventilatory inhomogeneity in this group of patients.

24

Authors: Souza Fernández, Marta

Introduction: The shoulder is the articulation of the human body with the highest range of movement, due to the anatomical elements that compose it, which, in addition, give it enormous complexity. The structures it contains provide functionality to the upper limb, but are also exposed to multiple pathologies. Musculoskeletal disorders of the shoulder develop and become more complex over time until the onset of joint pain. There are data that one in three people experience shoulder pain at some stage of their lives and even about half of the population suffers at least one episode annually, plus the incidence is 30-50% of all sports injuries, according to various authors. Shoulder pain occupies the second place after low back pain, and affects approximately 16-21% of the population. The most frequent cause is subacromial impingement syndrome, estimated 44-60% of medical consultations for said pain. In Spain, prevalence figures of 78 cases per 1,000 inhabitants have been reported, leading to a significant consumption of care resources and productive losses due to absenteeism in the workplace. The majority of those affected are under the age of 60. Its symptoms are usually related to the work performed or the sports activity performed, especially in those that require the use of the hand above the head. Rotator cuff tendinopathy is the most common cause of upper limb dysfunction pain and increases its appearance with age. Most of the population that suffers from these shoulder discomfort is due to the set of muscles called the rotator cuff and the surrounding tissues. Treatment includes surgical and non-surgical methods. The goals of non-surgical treatment will be to reduce subachromial pain and inflammation, treat the compromised rotator cuff, and restore shoulder function. Objective: Our review aims to look for the different treatments that demonstrate the efficacy of physiotherapy for this pathology. This literature review aims to analyze the different techniques of physical therapy in the treatment of supraspinatus tendinopathy, in order to capture whether there is evidence as to whether or not the conservative treatments offered by physiotherapy through its various techniques are effective, in order to avoid surgery, pharmacological treatments and/or more invasive therapies. Material and method: a systematic review is carried out in Medline, Pedro, Cochrane, and Science Direct on the treatment of physiotherapy against the subachromial syndrome, using the following keywords: physiotherapy, physicaltherapy, rehabilitation, impingementsyndrome, subacromialsyndrome, shoulder, pain. The search is limited to articles published in the last five years. Following the application of the inclusion and exclusion criteria, 16 articles were selected and deemed appropriate to meet the objectives of the review. Results: After analyzing the selected studies, it is observed that in each of them there are positive results in the application of physiotherapy treatment, conservative, by applying one or more techniques to the pathology of supraspinatus tendinopathy without taking into account the etiology. Conclusion: There is evidence about the treatment of physiotherapy in patients with supraspinatus tendinopathy.

50

Authors: Pons Albert, Francesc

One of my main concerns as a physical trainer has always been to prevent my players/ras from getting injured. Specifically, the rupture injury of the anterior cruciate ligament is a very serious and common injury among basketball players/ ace, field to which I dedicate myself. This is why in this document I have tried to compile and compare the main scientific studies that address the issue from a sports point of view. The objective of this paper is to offer a global and updated vision focused on the prevention and recovery of injury.

16

Authors: Toro Martín, S

Giving birth is certainly one of the situations in a woman´s life that causes the strongest pain in her life, which on various occasions can be excessive and unbearable. Due to this, good pain management during delivery is essential so that the care provided by the health team is adequate and has quality. Currently, epidural analgesia is the most widely used during obstetric procedures related to childbirth, although this technique is invasive and like any invasive procedure, presents risks for pregnant women and the foetus. To develop this assignment a systematic bibliographic review has been carried out in order to analyze the existing literature on the subject in the most important scientific databases. Therefore, the objective of this study is to obtain remarkable information on the relationship that may exist between the use of epidural analgesia during labour and the increase in the length of the dilation phase, the expulsion phase or if it influences in any way the increment in the number of deliveries that require the use of supporting instruments or involve any other complicated situations. In conclusion, it can be confirmed that epidural analgesia is related to a longer dilation time, an increment on the time dedicated to the expulsion phase, in the same way that there is an increment in deliveries that require the use of supporting instruments, the use of medications such as oxytocin or the association with additional complications.

20

Authors: León Soto, M

Objectives: Determine the main interventions of the midwife for the prevention of perineal trauma that occurs during childbirth, review and detail the effectiveness of the main interventions during pregnancy and delivery for the prevention of perineal trauma, describe the role of the midwife on interventions for the prevention of perineal trauma. Method: Bibliographic review of scientific articles in databases PubMed, MedLine, Cinahl, Scielo, Dialnet, Cuidatge, published in the last 5 years, in Spanish, English and Portuguese. Books and some guides have also been included. No ethical restrictions or limitations were made. The abstracts and, if necessary, the complete articles were reviewed, taking into account all the articles that met the selection criteria. Results / Discussion: Interventions of the midwife who have enough literature to have scientific support in the prevention of perineal trauma are: Exercises during pregnancy to strengthen the pelvic floor, perineal massage during pregnancy, maternal position during the expulsive, spontaneous pushing techniques, hands-free or hand-off technique and application of hot packs. Conclusion: We have indicated several interventions as beneficial in the prevention of perineal trauma. However, more reliable studies are needed to support these interventions, we must join efforts in the dissemination of the results among the different health professionals for their subsequent application to the daily work and thus make interventions for the prevention of perineal trauma a reality.

21

Authors: Garnica Martínez, I

During the last century the management of childbirth has undergone an intense transformation. Until half a century ago, most deliveries took place in the pregnant woman’s own home, assisted by a midwife, where health conditions were generally not optimal (no running water and heating) as well as the nutritional and health conditions of many women. All this, together with the fact that the number of children was high and the short inter-seasonal space, made the maternal and infant mortality rate during childbirth very high. Over the years, the practice of giving birth in the hospital was imposed, which significantly reduced these mortality rates. However, the process of hospitalization of births also brought with it some negative consequences: an increase in the number of caesarean sections, episiotomies and inductions of childbirth far above the recommendations of the World Health Organization (WHO) and, in general, a "dehumanization" of the process. With the rigid application of hospital protocols and the widespread use of epidural analgesia in childbirth, It is extremely common to disconnect women with their experiences and use techniques and drugs to conduct a childbirth in which the complex hormonal mechanism that guides it is disrupted. One of the most widely used drugs in obstetrics, along with anesthetics, is synthetic oxytocin in order to produce or increase the number and intensity of uterine contractions. The use of this endogenous oxytocin analogue causes the hormonal feedback system to be interrupted and the endogenous oxytocin secretion to be completely modified. The most well-known physiological functions of oxytocin have to do with the production of contractions as an engine of childbirth and the initiation and maintenance of breastfeeding. However, it has been found that the hormone oxytocin is responsible for modulating many behaviors of relationship and attachment of the human being among other functions, of which, there is still a great ignorance. This literature review attempts to explain what short- and long-term consequences the massive use of synthetic oxytocin may have during in-hospital management of childbirth.