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1.
Mar Environ Res ; 193: 106283, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38128348

RESUMEN

The subpopulation and/or contingent structure of Atlantic bluefin tuna (Thunnus thynnus) within the Mediterranean Sea is undefined, leading to uncertainty regarding the best strategy for an effective assessment and management of this highly exploited stock. This study aimed to reconstruct temperatures experienced by Atlantic bluefin tuna during the early life period (<3.5 months) using clumped isotope temperature proxy, an innovative geothermometer for carbonates, that does not require previous knowledge of other environmental parameters such as water oxygen composition. We examined otolith chemistry in fish captured from 3 different areas of the Mediterranean Sea and adjacent waters. We found that mean seasonal temperature estimates from clumped isotopes did not differ significantly from satellite derived and otolith oxygen stable isotopic ratios derived temperatures, except for the central Mediterranean Sea, were clumped isotopes derived temperatures were significantly higher than satellite derived temperatures. However, the sensitivity of the clumped isotope thermometer was found to be lower than that based on oxygen fractionation equation, with high variance observed in the clumped isotopes derived temperature estimates. We also observed that clumped isotope derived temperatures were undistinguishable among bluefin tuna captured in the Gibraltar Strait, the central, and eastern Mediterranean Sea. In this paper, we discuss the major sources of uncertainty in temperature reconstructions using bluefin tuna otoliths.


Asunto(s)
Membrana Otolítica , Atún , Animales , Temperatura , Mar Mediterráneo , Isótopos , Oxígeno , Océano Atlántico
2.
Chemosphere ; 339: 139577, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37480957

RESUMEN

Peppers are fruits that grow on plants of the genus Capsicum and are popular for their use in gastronomy as a condiment and for their anti-inflammatory and anti-cancer properties due to their phytocompounds such as flavonoids, polyphenols, or alkaloids. Semiconductor zinc oxide (ZnO) nanoparticles (NPs) were synthesized using a green approach employing natural aqueous extracts of several varieties of peppers (jalapeño, morita, and ghost). The obtained NPs were characterized by different techniques, and their photocatalytic and antibacterial activity was studied. The signal at 620 cm-1 in the FTIR spectra belonging to the Zn-O bond, the appearance of the main peaks of a hexagonal wurtzite structure in the XRD pattern, and the characteristic signals in the UV-Vis spectra confirm the correct formation of ZnO NPs. The photocatalytic activity was analyzed against Methylene Blue (MB), Rhodamine B (RB), and Methyl Orange (MO) under UV and sunlight. All syntheses were able to degrade more than 93% of the pollutants under UV light. Antibacterial assays were performed against gram-positive and gram-negative bacteria. All syntheses exhibited antibacterial activity against all bacteria and maximum growth inhibition against Bacillus subtilis. The prominent results demonstrate that natural aqueous extracts obtained from peppers can be used to synthesize ZnO NPs with photocatalytic and biomedical applications.


Asunto(s)
Nanopartículas del Metal , Nanopartículas , Óxido de Zinc , Óxido de Zinc/farmacología , Óxido de Zinc/química , Antibacterianos/farmacología , Antibacterianos/química , Bacterias Gramnegativas , Bacterias Grampositivas , Extractos Vegetales/farmacología , Extractos Vegetales/química , Nanopartículas/química , Nanopartículas del Metal/química , Pruebas de Sensibilidad Microbiana
3.
J Environ Radioact ; 265: 107213, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37321136

RESUMEN

The monthly depositional fluxes of 7Be, 210Pb and 40K were measured at Malaga, (Southern Spain) from 2005 to 2018. In this work, the depositional fluxes of these radionuclides are investigated and their relations with several atmospheric variables have been studied by applying two popular machine learning methods: Random Forest and Neural Network algorithms. We extensively test different configurations of these algorithms and demonstrate their predictive ability for reproducing depositional fluxes. The models derived with Neural Networks achieve slightly better results, in average, although similar, having into account the uncertainties. The mean Pearson-R coefficients, evaluated with a k-fold cross-validation method, are around 0.85 for the three radionuclides using Neural Network models, while they go down to 0.83, 0.79 and 0.8 for 7Be, 210Pb and 40K, respectively, for the Random Forest models. Additionally, applying the Recursive Feature Elimination technique we determine the variables more correlated with the depositional fluxes of these radionuclides, which elucidates the main dependences of their temporal variability.


Asunto(s)
Plomo , Monitoreo de Radiación , Radioisótopos/análisis , Algoritmos , Aprendizaje Automático
4.
Rev Neurol ; 72(7): 239-249, 2021 Apr 01.
Artículo en Español | MEDLINE | ID: mdl-33764493

RESUMEN

INTRODUCTION: We speak of advanced dementia when all the cognitive functions show a generalized and important affectation. In the course of advanced dementia it will be necessary to assess the suitability of the use or not of psychometric instruments. OBJECTIVE: To determine the utility of the psychometric instruments of cognitive assessment that determines the neuropsychological evaluation of advanced dementia. Through the research of studies of the databases PubMed, PsychInfo, MedLine and Cochrane. The searches combined terms of advanced dementia, cognitive evaluation and pshycometric tests. Ten studies were included in the research. DEVELOPMENT: The ten selected studies show how different psychometric tests can be used for the cognitive evaluation of patients with advanced dementia: SIB, SIB-s, M-OSPD, SCIP, SMMSE, mTSI and SIRS. Five of the ten studied the usefulness of these tests in their original version, and the remaining five verified the validity and reliability of the abbreviated versions of some of these tests. CONCLUSIONS: There are few scales that meet the appropriate psychometric characteristics to be able to carry out a cognitive evaluation effectively taking into account the difficulty that this poses for a person with severe dementia, but the instruments mentioned overcome the main limitations of other tools by presenting no effect ceiling and minimal floor effect.


TITLE: Evaluación neuropsicológica de la demencia avanzada: ¿son de utilidad los instrumentos psicométricos de valoración cognitiva? Una revisión sistemática.Introducción. Hablamos de demencia avanzada cuando todas las funciones cognitivas muestran una generalizada e importante afectación. En el transcurso de la demencia avanzada será necesario valorar la idoneidad de la utilización o no de instrumentos psicométricos. Objetivo. Determinar la utilidad de los instrumentos psicométricos de valoración cognitiva dirigidos a la evaluación neuropsicológica de la demencia avanzada. Material y métodos. Se realizó una búsqueda de estudios en las bases de datos PubMed, PsychInfo, Medline y Cochrane. Las búsquedas combinaron términos de demencia avanzada, valoración cognitiva y pruebas psicométricas. Se incluyeron 10 estudios en la investigación. Desarrollo. Los 10 estudios seleccionados muestran cómo se pueden utilizar diferentes pruebas psicométricas para la valoración cognitiva de pacientes con demencia avanzada: Severe Impairment Battery, Short version of the Severe Impairment Battery, Ordinal Scales of Psychological Development modified, Severe Cognitive Impairment Profile, Severe Minimental State Examination, Modified version of the Test for Severe Impairment y Severe Impairment Rating Scale. Cinco de los 10 estudiaron la utilidad de esas pruebas en su versión original, y los cinco restantes comprobaron la validez y la fiabilidad de las versiones abreviadas de algunas de estas pruebas. Conclusiones. Son pocas las escalas que reúnen las características psicométricas adecuadas para poder realizar una valoración cognitiva de forma eficaz, teniendo en cuenta la dificultad que ésta supone para una persona con demencia avanzada, pero los instrumentos mencionados superan las principales limitaciones de otras herramientas al presentar ausencia de efecto techo y mínimo efecto suelo.


Asunto(s)
Demencia/diagnóstico , Pruebas Neuropsicológicas , Humanos , Pruebas de Estado Mental y Demencia , Psicometría , Índice de Severidad de la Enfermedad
6.
Phys Rev Lett ; 121(24): 241101, 2018 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-30608723

RESUMEN

The gamma-ray sky has been observed with unprecedented accuracy in the last decade by the Fermi -large area telescope (LAT), allowing us to resolve and understand the high-energy Universe. The nature of the remaining unresolved emission [unresolved gamma-ray background (UGRB)] below the LAT source detection threshold can be uncovered by characterizing the amplitude and angular scale of the UGRB fluctuation field. This Letter presents a measurement of the UGRB autocorrelation angular power spectrum based on eight years of Fermi-LAT Pass 8 data products. The analysis is designed to be robust against contamination from resolved sources and noise systematics. The sensitivity to subthreshold sources is greatly enhanced with respect to previous measurements. We find evidence (with ∼3.7σ significance) that the scenario in which two classes of sources contribute to the UGRB signal is favored over a single class. A double power law with exponential cutoff can explain the anisotropy energy spectrum well, with photon indices of the two populations being 2.55±0.23 and 1.86±0.15.

7.
Actas Urol Esp (Engl Ed) ; 42(2): 126-132, 2018 Mar.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29107431

RESUMEN

OBJECTIVE: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. METHODS: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10ml of lidocaine gel and 50ml of lidocaine solution were instilled in the bladder. A 4.8Fr ureteral stent was placed using a 15.5Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. RESULTS: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. CONCLUSIONS: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia.


Asunto(s)
Atención Ambulatoria/métodos , Anestesia Local/métodos , Catéteres de Permanencia , Stents , Enfermedades Ureterales/terapia , Cateterismo Urinario/métodos , Administración Intravesical , Adulto , Anciano , Anestésicos Locales/administración & dosificación , Catéteres de Permanencia/efectos adversos , Cistoscopía , Femenino , Fluoroscopía , Humanos , Instilación de Medicamentos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Estudios Retrospectivos , Stents/efectos adversos , Cateterismo Urinario/efectos adversos
8.
J Environ Radioact ; 178-179: 325-334, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28965023

RESUMEN

The monthly bulk depositional fluxes of three natural radionuclides (7Be, 210Pb and 40K) were measured at a Mediterranean coastal station (Málaga) over an 11-year period from 2005 to 2015. The mean annual depositional fluxes of 7Be, 210Pb and 40K were 1215, 144 and 67 Bq m-2 year-1 respectively, showing a clear seasonal trend with minimum values recorded during summer and maximum values in winter. The rainfall regime with dry summers allows estimating the dry deposition. Assuming constant dry deposition through each year, 7Be, 210Pb and 40K would account for 12.5, 26.5 and 33% of the bulk fallout respectively which indicates that deposition for 210Pb and 40K are significantly higher than 7Be. The precipitation-normalized enrichment factor alpha used to explain seasonal variations in the depositional fluxes of radionuclides with respect the rainfall, indicates higher depositional fluxes during spring and summer than expected from the amount of rainfall. Despite their different origin, 210Pb and 7Be monthly depositional fluxes have strong correlation. The atmospheric deposition fluxes of 7Be, 210Pb and 40K were controlled mainly by the amount of rainfall (r = 0.89, 0.91 and 0.66 respectively). Moreover, principal component analysis was applied to the datasets and deposition of radionuclides and rainfall in the same component highlighting the importance of the washout mechanism. The mean depositional velocity of aerosols evaluated using 7Be and 210Pb are similar and are compared to other published values.


Asunto(s)
Contaminantes Radiactivos del Aire/análisis , Berilio/análisis , Radioisótopos de Plomo/análisis , Radioisótopos de Potasio/análisis , Monitoreo de Radiación , Aerosoles , Estaciones del Año , España
9.
Scanning ; 37(6): 389-92, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26011683

RESUMEN

In this work, the influence of substrate on the morphology of ZnS thin films by chemical bath deposition is studied. The materials used were zinc acetate, tri-sodium citrate, thiourea, and ammonium hydroxide/ammonium chloride solution. The growth of ZnS thin films on different substrates showed a large variation on the surface, presenting a poor growth on SiO2 and HfO2 substrates. The thin films on ITO substrate presented a uniform and compact growth without pinholes. The optical properties showed a transmittance of about 85% in the visible range of 300-800 nm with band gap of 3.7 eV.

10.
Scanning ; 37(3): 165-71, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25676058

RESUMEN

The bimetallic nickel-tungsten catalysts were prepared via solvothermal method. The X-ray Diffractometer (XRD) analysis revealed that the corresponding peaks at 14°, 34°, and 58° were for tungsten disulfide (WS2 ) hexagonal phase. The catalysts displayed different crystalline phase with nickel addition, and as an effect the WS2 surface area decreased from 74.7 to 2.0 m(2) g(--1) . In this sense, high-resolution transmission electron microscopy (HRTEM) showed the layers set in direction (002) with an onion-like morphology, and in the center of the particles there is a large amount of nickel contained with 6-8 layers covering it. The catalytic dehydration of 2-propanol was selective to propene in 100% at 250 °C for the sample with 0.7 of atomic ratio of Ni/Ni + W.

11.
J Fish Biol ; 84(6): 1876-903, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24890407

RESUMEN

This study deals with important methodology issues that affect age estimates of eastern Atlantic bluefin tuna Thunnus thynnus using dorsal fin spines. Nearly 3800 spine sections were used from fish caught in the north-east Atlantic Ocean and western Mediterranean Sea over a 21 year period. Edge type and marginal increment analyses indicated a yearly periodicity of annulus formation with the translucent bands (50% of occurrence) appearing from October to May. Nucleus vascularization seriously affected specimens older than 6 years, with the disappearance of 40-50% of the presumed annuli by that age. An alternate sectioning location was a clear improvement and this finding is an important contribution to the methodology of using this structure for ageing the full-length range of eastern T. thynnus. Finally, there were no significant differences between the coefficients of von Bertalanffy growth model estimated from mean length at age data (L∞ = 327.4; k = 0.097; t0 = -0.838) and those estimated from the growth curves accepted for the eastern and western T. thynnus management units.


Asunto(s)
Envejecimiento , Aletas de Animales/anatomía & histología , Atún/crecimiento & desarrollo , Animales , Océano Atlántico , Mar Mediterráneo , Atún/anatomía & histología
12.
Semergen ; 40(4): 211-7, 2014.
Artículo en Español | MEDLINE | ID: mdl-24529529

RESUMEN

An ectopic pregnancy is the implantation and development of the ovum fertilized outside the endometrial cavity. Its incidence has increased in the last 30 years, and although its morbimortality has decreased, it is still the first cause of mortality in the first trimester of the pregnancy. Early suspicion is important, particularly in women of fertile age and with risk factors indicative of an extrauterine gestation. The symptomatology is usually amenorrhea, abdominal pain, metrorrhagia, general pregnancy symptoms, and even syncope and shock. The diagnosis of ectopic pregnancy is based on the clinical information, analytical results on mother blood and urine, ultrasound examination, transvaginal culdocentesis, laparoscopic or laparotomic inspection, and a histological study. The treatment can be surgical (salpingostomy or salpingectomy), medical (methotrexate) or expectant, depending on the factors of the ectopic pregnancy: early diagnosis, presence of acute complications, clinical condition of the patient, etc.


Asunto(s)
Dolor Abdominal/etiología , Embarazo Ectópico/terapia , Atención Primaria de Salud , Femenino , Humanos , Laparoscopía/métodos , Laparotomía/métodos , Embarazo , Embarazo Ectópico/diagnóstico , Embarazo Ectópico/epidemiología , Factores de Riesgo , Salpingectomía/métodos , Salpingostomía/métodos
13.
Int J Clin Pract ; 66(9): 891-6, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22897466

RESUMEN

AIM: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. METHODS: Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. RESULTS: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004). CONCLUSIONS: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.


Asunto(s)
Infecciones por Enterobacteriaceae/epidemiología , Infecciones Urinarias/epidemiología , Anciano , Enterobacteriaceae/enzimología , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Infecciones Urinarias/microbiología , Resistencia betalactámica , beta-Lactamasas/biosíntesis
14.
Int J Impot Res ; 24(3): 110-3, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22258063

RESUMEN

Testosterone deficiency syndrome (TDS) is a clinical and biochemical entity related to sexual and cardiovascular health. Hypertension, diabetes mellitus (DM), dyslipidemia and overweight are four clinical factors strongly related to cardiovascular illnesses. The aim of our study was to determine if the presence and number of cardiovascular risk factors was related to total testosterone levels and the presence of biochemical TDS. We retrospectively analyzed 384 patients referred to our center for prostate biopsy between September 2007 and December 2009. Variables age, height, weight, body mass index (BMI), tobacco use, alcohol intake, hypertension, DM, dyslipidemia (hypercholesterolemia/hypertriglyceridemia) and overweight (BMI>25) were recorded prospectively. Hormonal profile was determined as part of our clinical protocol. We used 231 and 346 ng dl(-1) as total testosterone cut-points (8-12 nmol l(-1)) for diagnosis of biochemical TDS, following ISA-ISSAM-EAU Guidelines. We analyzed the relationship between testosterone levels and the presence of hypertension, DM, dyslipidemia and overweight, and with the number of these cardiovascular risk factors. Mean age was 66 ± 8 years. Prevalence of TDS was 6.5% within the 231 ng ml(-1) cutoff point and 28.4% for the 346 ng dl(-1) cutoff point. Levels of testosterone were related to hypertension (P=0.007), dyslipidemia (P=0.013), overweight (P=0.036) and the number of cardiovascular risk factors (P=0.018). The prevalence of TDS in our population is comparable to data from international studies. Testosterone levels decrease as the number of cardiovascular risk factors rise.


Asunto(s)
Hiperlipidemias/sangre , Hipertensión/sangre , Sobrepeso/sangre , Próstata/patología , Testosterona/sangre , Anciano , Biopsia , Enfermedades Cardiovasculares , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Factores de Riesgo , Testosterona/deficiencia
15.
Actas Urol Esp ; 36(5): 291-5, 2012 May.
Artículo en Español | MEDLINE | ID: mdl-22266257

RESUMEN

AIM: Erectile dysfunction (ED) is a very common condition in the general population. ED is closely related to Hypertension (HT), Diabetes Mellitus (DM), Dyslipidemia (DLP) and Metabolic Syndrome (MS). This study has aimed to clarify whether the presence and severity of ED are related to the presence and number of cardiovascular risk factors (CVRF). MATERIAL AND METHODS: We retrospectively analyzed the characteristics of 242 males referred to our center for a prostate biopsy from September 2007 to December 2009. The following variables were collected prospectively: age, height, weight, body mass index (BMI), AHT, DM, DLP and obesity (BMI<30 kg/m(2)). The Erection Hardness Score Questionnaire was used to assess erectile function. We analyzed the relation between the presence and severity of ED and the presence of HT, DM, DLP and obesity. We analyzed the clinical variables based on the presence or absence of ED and in relationship to its severity. RESULTS: The presence of ED was related to HT (OR: 1.805 [1.128-2.887]; p=0.013), DM (OR 3.585 [1.613-7.966]; p=0.001) and Dyslipidemia (OR: 1.928 [1.062-3.500]; p=0.029). Erectile function was not related to Obesity (OR: 0.929 [0.522-1.632]; p=0.795). Patients with ED were more likely to have more CVRF (p=0.009) and the severity of ED was related to the presence of HT (p<0.001), DM (p<0.001), DLP (p=0.001) and the number of CVRF (p<0.001). CONCLUSIONS: The presence and severity of ED correlate with the presence of HT, DM, Dyslipidemia and the number of DVRF.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Disfunción Eréctil/complicaciones , Anciano , Enfermedades Cardiovasculares/epidemiología , Disfunción Eréctil/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
16.
Med Intensiva ; 36(2): 103-37, 2012 Mar.
Artículo en Español | MEDLINE | ID: mdl-22245450

RESUMEN

The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH> 1500 IU/L, and the presence of thrombocytopenia <150 x 10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (<48 h from the onset of symptoms), with a dose of 75 mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume <10 ml / kg and plateau pressure <35 mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.


Asunto(s)
Antivirales/uso terapéutico , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/diagnóstico , Gripe Humana/terapia , Unidades de Cuidados Intensivos , Corticoesteroides/uso terapéutico , Algoritmos , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/tratamiento farmacológico , Oxigenación por Membrana Extracorpórea , Humanos , Vacunas contra la Influenza/efectos adversos , Gripe Humana/complicaciones , Gripe Humana/mortalidad , Gripe Humana/virología , Pronóstico , Respiración Artificial , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/virología , Factores de Riesgo , Índice de Severidad de la Enfermedad
17.
Eur Rev Med Pharmacol Sci ; 15(8): 855-62, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21845794

RESUMEN

BACKGROUND AND OBJECTIVES: Little is known about the impact of comorbid psychiatric symptoms in health related quality of life (HRQL) in patients with HIV infection. The aim of this investigation was to describe depressive symptoms and the impact in HRQL in HIV infected people. MATERIALS AND METHODS: A cross-sectional study over 150 HIV-outpatients in a tertiary hospital was designed. Depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. HRQL data were collected by disease-specific questionnaire MOS-HIV. Researchers' team designed a specific template to get rest of the data. RESULTS: Almost three-quarters of the population were men. After adjusting for gender and age, HIV-related symptoms and presence of depression were found to be negatively associated with all the Medical Outcomes Study HIV Health Survey (MOS-HIV) general domains and in the Physical Health Summary score and Mental Health Summary score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Quality of life and depression should be monitored in follow-up of HIV infected patients. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV.


Asunto(s)
Depresión/complicaciones , Infecciones por VIH/psicología , Estado de Salud , Calidad de Vida/psicología , Adulto , Factores de Edad , Estudios Transversales/estadística & datos numéricos , Depresión/diagnóstico , Depresión/psicología , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Caracteres Sexuales
18.
HIV Med ; 12(1): 22-30, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20497251

RESUMEN

OBJECTIVES: Health-related quality of life (HRQL) is used in the assessment of chronic illness. Regarding HIV infection, HRQL assessment is an objective for physicians and institutions since antiretroviral treatment delays HIV clinical progression. The aim of this study was to determine the factors with the most influence on HRQL in HIV-infected people and to create a predictive model. METHODS: We conducted a cross-sectional study in 150 patients in a tertiary hospital. HRQL data were collected using the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. The research team created a specific template with which to gather clinical and sociodemographic data. Adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. Logistic regression models were used to identify determinants of HRQL. RESULTS: HIV-related symptoms and presence of depression were found to be negatively associated with all the MOS-HIV domains, the Physical Health summary score and the Mental Health summary score. Patients receiving protease inhibitor (PI)-based treatment had lower scores in four of the 11 domains of the MOS-HIV questionnaire. Gender, hospitalization in the year before enrolment, depression and parenthood were independently related to the Physical Health Score; depression and hepatitis C virus coinfection were related to the Mental Health Score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV infection can be considered a chronic disease with the prospect of long-term survival. Quality of life should be monitored in follow-up of HIV-infected patients. The assessment of HRQL in this population can help us to detect problems that may influence the progression of the disease. This investigation highlights the importance of a multidisciplinary approach to HIV infection.


Asunto(s)
Infecciones por VIH/psicología , Sobrevivientes de VIH a Largo Plazo/psicología , Indicadores de Salud , Hepatitis C Crónica/psicología , Calidad de Vida , Adulto , Fármacos Anti-VIH/uso terapéutico , Actitud Frente a la Salud , Niño , Trastorno Depresivo/complicaciones , Métodos Epidemiológicos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Hepatitis C Crónica/complicaciones , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Factores Socioeconómicos
19.
Med Intensiva ; 34(4): 256-67, 2010 May.
Artículo en Español | MEDLINE | ID: mdl-20096484

RESUMEN

Nosocomial infections are one of the most important problems occurring in Intensive Care Units. For this reason, the epidemiology and impact of these infections on critical patients must be known. Based on the data from the ENVIN-UCI study, the rates and etiology of the main nosocomial infections, such as ventilator-associated pneumonia, urinary tract infection and primary and secondary bloodstream infection, have been described. A review of the literature regarding the impact of different nosocomial infections on critically ill patients, particularly those caused by multidrug-resistant bacteria, was also performed.


Asunto(s)
Infección Hospitalaria/epidemiología , Infección Hospitalaria/complicaciones , Humanos
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