Protocol for assessing mortality reduction with the early use of noninvasive ventilation in prehospital emergency services: A multicentre, observational cohort study in Madrid, Spain.

BACKGROUND: Acute respiratory failure (ARF) has become one of the most prevalent serious pathologies encountered in the emergency medical service (EMS). In hospital settings, noninvasive ventilation (NIV) therapy prevents complications from more aggressive treatments for that condition. However, the scarce evidence on the benefits of NIV in prehospital EMS (i.e., during transport to the hospital) is inconclusive. OBJECTIVES: To determine whether the administration of NIV during prehospital EMS in cases of ARF reduces in-hospital mortality compared with starting NIV on arrival to in-patient EMS. METHODS: This is a multicentre, observational, prospective cohort study. We recruited a total of 317 patients from the Madrid region (Spain) who were prescribed NIV for their ARF using a nonprobabilistic consecutive sampling method. Analyses of the main outcome (in-hospital mortality) and secondary outcomes (length of hospital stay, readmissions, percentage of intensive care unit admissions, and cost-effectiveness) will include descriptive analyses of patients' characteristics, as well as bivariate and multivariate analyses and cost-effectiveness analysis. DISCUSSION: This study will provide data on NIV management in prehospital and in-patient EMS in patients with ARF. Results will contribute to the existing evidence on the benefits of NIV in the context of prehospital EMS while underlining the importance of a standardized formal training for physicians and nurses working in prehospital and in-patient EMSs. CONCLUSION: The VentilaMadrid study will provide valuable data on the clinical factors of patients receiving NIV in prehospital EMS. Further, were our hypothesis to be confirmed, our results would strongly suggest that the administration of NIV in prehospital EMS by medical and nursing profesionals formally trained in the technique reduces mortality and improves prognoses.

[Muscle mass, muscle strength, and other functionality components in institutionalized older adults from Gran Caracas-Venezuela]. / Masa muscular, fuerza muscular y otros componentes de funcionalidad en adultos mayores institucionalizados de la Gran Caracas-Venezuela.

The present study has as objective to describe behavior of the different components of functionality and muscular mass, in institutionalized older people. Because levels of muscular mass have been associated with reduced levels of force, activity, functionality, depression of the immune function and increase of the morbidity and mortality risk. Were evaluated 152 elderly people older than 60 years old, men and women, of 14 geriatric centers of the Gran Caracas. Anthropometrical variable was measured to value the muscular mass and the body mass index. It was evaluated: hand isometric force, walking time 4.88 m and getting up of a seat. Descriptive statistic was carried out for all the variables, t of Student, Anova and Scheffé. It was observed that 80 years older elderly as well as, women present higher levels of disability, performed motor activities (to walk and to get up of a seat and a impair in physical conditions (lean mass and muscular strength) that interfere with functional status.

Resolution of ofloxacin-ciprofloxacin and ofloxacin-norfloxacin binary mixtures by flow-injection chemiluminescence in combination with partial least squares multivariate calibration.

A flow-injection chemiluminescence (CL) method is described for the determination of ciprofloxacin (CIP), norfloxacin (NOR) and ofloxacin (OFL), commonly used antibiotics of the fluoroquinolones family. The method is based on the CL reaction of the fluoroquinolones with tris(2,2'-bipyridyl) ruthenium(II) and Ce (IV), in sulfuric acid medium. The maximum CL emission, given at 0.45 min for CIP, at 0.35 min for NOR and at 0.04 min for OFL, respectively, were measured, allowing the simple application of the proposed method to the routine analysis of the antibiotics. The methods were applied to the determination of CIP, NOR and OFL, in several pharmaceutical preparations, with very satisfactory results, and validated by a previously reported HPLC method. The time-resolved equipment allowed the measurement of the kinetic evolution of the chemiluminescence signals. In base to the differences in the kinetic behaviour of ofloxacin with respect to ciprofloxacin and norfloxacin, binary mixtures of the drugs were resolved by using the time-resolved chemiluminescence signals, in combination with first-order partial least-squares (PLS) multivariate calibration.

Simultaneous determination of nafcillin and methicillin by different fluorimetric techniques using partial least-squares calibration.

The simultaneous determination of nafcillin and methicillin was accomplished by constant wavelength synchronous fluorimetry, in combination with partial least-squares multivariate calibration. The total luminescence information of the compounds was used to optimize the spectral data set to perform the calibration. A calibration set of standard samples was designed by combination of a factorial design, with three levels for each factor, and a central composite design. A comparative study of the results obtained using the excitation, the emission, the constant wavelength synchronous and the constant energy synchronous spectral data as analytical signals was performed. The data, set composed of the constant wavelength synchronous spectra, was selected as the analytical signal. The method was successfully applied to the determination of nafcillin and methicillin in mixtures.

Analysis of binary mixtures of cephalothin and cefoxitin by using first-derivative spectrophotometry.

A method for the analysis of two-component mixtures of cephalothin and cefoxitin using zero-crossing first-derivative spectrophotometry is described. This technique permits the quantification of these drugs with closely overlapping spectral bands without any separation step. Linear calibration graphs of first-derivative values at 235.00 and 236.75 nm for cephalothin and cefoxitin, respectively, with negligible intercepts were obtained versus concentration in the range 4.0-32.0 micrograms ml-1 for both antibiotics. This paper presents a systematic examination of the experimental data by applying an exhaustive statistical analysis to demonstrate the validity of the method. The results of the determination of these antibiotics in mixtures of injectable dosage forms are also presented, together with their determinations in physiological serum and glucosed physiological serum.

Análogos de factor liberador de hormona luteinizante en precocidad sexual: Presentación de un caso clínico / Analogues of luteinizing hormone realizing factor in sexual precocity: Case presentation

Se presenta caso de paciente femenina de 7 años de edad que inicia cambios sexuales secundarios siendo diagnosticada como pubertad precoz isosexual. Se sometió a tratamiento con Análogos de Factor Liberador de Hormona Luteinizante(LHRH), en el Hospital General de Boston Massachusetts, obteniéndose resultados positivos tales como regresión de caracteres sexuales y una mayor talla final que la esperada

Simultaneous determination of the binary mixtures of cefsulodin and clavulanic acid by using first-derivative spectrophotometry.

Two-component mixtures of cefsulodin and clavulanic acid were analysed by a first-derivative spectrophotometric method using a zero-crossing technique of measurement. The relative ease offered by this derivative technique for the quantification of these drugs, with closely overlapping spectral bands, was clearly demonstrated. As the absorption band of clavulanic acid closely overlaps with that of cefsulodin, both direct and derivative spectrophotometric methods have been investigated and evaluated by an exhaustive statistical analysis of the experimental data. The first-derivative spectrophotometric method was found to be more rapid, accurate and reproducible. The procedure does not require any separation step. The calibration graphs were linear in the range 2.0-56.0 micrograms ml-1 for cefsulodin and 2.0-28.0 micrograms ml-1 for clavulanic acid. The lower detection limits of cefsulodin and clavulinic acid (P 0.05 level) were calculated to be 0.16 and 0.24 microgram ml-1, respectively. Mixtures of cefsulodin and clavulanic acid in ratios of 1:4-7:2 were satisfactorily resolved. Both components were also determined in physiological solutions used to prepare intravenous infusions of these antibiotics.

Spectrofluorimetric analysis of cefuroxime in pharmaceutical dosage forms.

A fluorimetric method has been developed for the quantitative analysis of cefuroxime, based upon the formation of a fluorescent derivative formed by alkaline hydrolysis with 1.0 M sodium hydroxide and heating at 100 degrees C for 60 min. The fluorescent product gave excitation and emission maxima at 380 and 436 nm, respectively. The method was performed in aqueous solution adjusted to pH 10.5 by addition of phosphate buffer solution. The calibration curve was found to be linear in the range of concentrations 0.050-1.70 micrograms ml-1. The lower limit of detection was 1.0 x 10(-2) micrograms ml-1. The method was applied to authentic pharmaceutical preparations containing cefuroxime sodium or cefuroxime axetil, the 1-(acetyloxy) ethyl ester of the drug, and was found to be satisfactory. Cefuroxime sodium was also determined in physiological solutions used to prepare intravenous infusions of this antibiotic.

New rapid assay for methicillin by spectrofluorimetry in pharmaceutical dosage forms.

A method for the spectrofluorimetric determination of methicillin is proposed (lambda ex = 279 nm, lambda em = 379 nm), for concentrations between 0.030 and 10.0 micrograms ml-1. The method was performed in water, at pH 6.20 provided by addition of phosphate buffer solution. The values obtained for detection and determination limits were 0.0188 and 0.063 micrograms ml-1, respectively. The method was successfully applied to assay a commercial injection containing methicillin sodium monohydrate.

Spectrofluorimetric analysis of cefoxitin in pharmaceutical dosage.

A fluorescence method involving sample pre-treatment is investigated concerning the determination of cefoxitin. A fluorescent product is formed when samples containing cefoxitin are subjected to alkaline hydrolysis with 1.0M sodium hydroxide and heated for 60 min at 90 degrees . The fluorescence is measured in ethanol/water medium (50% v/v) at approximately pH 2.0 provided by adding of 0.1M hydrochloric acid. The fluorescence excitation and emission maxima were 317 and 400 nm, respectively. The quantitative range is between 0.020 and 1.40 mug/ml. A detection limit of 2 x 10(-3) mug/ml was found. The proposed method has been applied to the determination of cefoxitin in commercial injections, saline and glucosed physiological serum.

Phototautomerism in the lowest excited singlet state of 1-hydroxy-2-carboxyanthraquinone.

The dependence of the absorption and fluorescence spectra of 1-hydroxy-2-carboxy-anthraquinone on pH and Hammett acidity have been studied. This compound exhibits phototautomerism in its uncharged and its singly-charged anionic species in aqueous media. Its ground state (pK(a)) and lowest excited singlet-state (pK(a)( *)) dissociation constants have been determined by absorptiometric and fluorimetric titrations and the assignment of the pK(a) and pK( *)(a) values to the equilibria concerned has been carefully considered.