NPunto

5

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

Introduction: Labor pain is an important concern that pregnant women present at the time of giving birth. In recent years, plantar reflexology has been proposed as an adjuvant therapy to reduce said pain. Reflexology is a type of complementary medicine that uses the application of pressure to the feet with specific techniques. The objective of this review is to analyze the efficacy of plantar reflexology as an adjunct to relieve pain in childbirth. Method: A review of the scientific literature is carried out using the PubMed, Cinahl and Scopus databases. Studies conducted in the last eight years are selected, with full text and adequate methodological quality. Results: Plantar reflexology is an effective and reliable adjuvant in the management of labor pain. Regarding the duration of application of the therapy, it ranges between 20 and 60 minutes. The total number of participants in the review was 555 individuals. The instruments for pain assessment were the visual analogue scale (VAS) and the McGill Questionnaire. Conclusions: Plantar reflexology reduces the intensity of labor pain. It also improves other parameters such as the duration of labor, maternal anxiety, increases Apgar scores of the newborn, and increases maternal satisfaction with childbirth.

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Authors: Delgado Baena, A

Today, anemia is one of the most important public health problems and although its prevalence has decreased, we should not underestimate that about 30% of the population suffers from some type of anemia. On the other hand, 2.5% of the total population presents hematic physiological values outside the statistical normality, as is the case of athletes, African-Americans or pregnant women, where the function of oxygen transport to the tissues is not diminished in said patients cases. In addition, the World Health Organization has collected data that reveals the most common cause of anemia, being iron deficiency or deficiency, especially in risk groups such as the elderly or women of childbearing age. To make a correct diagnosis by the laboratory, it is necessary to determine parameters such as the erythrocyte mass value and other values such as the erythrocyte count, hematocrit or hemoglobin concentration inside the red blood cell.

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Authors: Pérez San Martín, S., Gómez Fernández, L

The aim of this article is to update knowledge in the study of microcytic anemias, the interpretation of both classical and novel blood count parameters and biochemical parameters used in the evaluation of anemias, the technological principles used by the different blood analysers and stress the importance of the pre-analytical phase to ensure the reliability and traceability of the results obtained.

20

Authors: Cruz Morales, R., Serna del Álamo, J.A

Coronary heart disease is the most important cause of death worldwide. Acute myocardial infarction is an acute coronary syndrome that is characterized by ischemia to a part of the heart muscle produced by the acute and total obstruction of one of the coronary arteries that do not feed Various studies consider that the lack of fiber consumption, diabetes, obesity, tobacco use, sedentary lifestyle, lack of exercise may be predisposing factors for the patient to suffer a heart attack. People who have suffered from this disease can be treated with drugs or catheterization, a technique that consists of breaking up the thrombus and preventing it from re-forming in that area. Thrombosis cases have increased during the COVID-19 pandemic.

23

Authors: Cubero Charco, B

When we talk about cardiogenic shock, we must know that it is a serious pathology, with multiple and varied etiology, with a difficult approach due to the extended tissue hypoperfusion state that can have fatal consequences since it quickly reaches the state of multiorgan failure if adequate treatment is not administered. Over the years, there have been quite a few advances in the knowledge of the physiopathology and development of CS, with the development of CS secondary to acute myocardial infarction being studied in greater detail, advancing with the incorporation of mechanical circulatory support devices to provide an alternative for people suffering from this condition. But it cannot be forgotten that it remains a pathology with a high mortality rate, which exceeds 50% in most cases, and requires an extraordinarily complex, specialized, and economically expensive treatment, which makes it impossible to access in all hospital centers. Like other cardiovascular pathologies, the diagnosis, prognosis, and treatment depend on the underlying cause that leads to this critical state that is CS, but it also has another key factor in determining the above, which is the healthcare center where this pathology is treated. As it is such a specific and complex disease, the effectiveness of centralizing patients who suffer from it in hospitals with specialized equipment, trained healthcare personnel, and evidence-based action protocols has been demonstrated.

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Authors: Bailo Lalaguna, A

Cardiovascular malaises are the leading cause of mortality in the world, and cardiac emergencies and arrhythmias constitute one of the most common causes of consultation and emergemcy intervention in emergency services in our country. In this article we will discuss them, their diagnosis, clinical manifestations and treatment. The objective of this article is to identify those pathologies who write a deadly ending if its treatment is delayed. Remembering the heart’s physiology will set the first stone to talk about these pathologies. From tachyarrhythmias to cardiogenic shock through lethal arrhythmias, and valvular and aortic pathologies.

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).

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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.

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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).

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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.

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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?