How the Sima de los Huesos was won.

Although the first discovery of a human fossil in the Sima de los Huesos took place in 1976, systematic excavations did not begin there until 1984. Since then, this site has been continuously excavated in month-long camps. The site is dated by different radiometric techniques to between 430,000 and 300,000 years ago. Until the 2023 campaign, just over 7000 human fossils have been recovered, constituting the largest collection of fossils prior to Homo sapiens ever discovered. The fossils correspond to a minimum of 29 individuals of both sexes and different ages at death, from preadolescents to a specimen of advanced age. Comparative anatomy and ancient DNA studies both suggest that this is a population closely related to Homo neanderthalensis. The great variety and extraordinary quality of the fossils recovered have allowed us to carry out a series of investigations that have greatly increased our knowledge about the evolution of Homo in the Middle Pleistocene. Among the most important discoveries, it has been possible to establish body size and proportions, the confirmation that the origin of the accumulation of human fossils was of an anthropic nature, that those past humans took care of disabled individuals and who were capable of having an oral language almost as complex and efficient as that of our own species.

Psychotropic Drug Prescription in Nursing Homes During the COVID-19 Pandemic.

BACKGROUND: To limit the introduction of coronavirus disease 2019 (COVID-19) into nursing homes, restrictive measures and social distancing were implemented; however, these caused an increase in affective disorders such as depression and anxiety and an alteration of the behavioral and psychological symptoms of dementia. Therefore, it is expected that prescription trends of psychotropic drugs in nursing homes during the pandemic may have changed significantly. OBJECTIVE: This study aims to compare patterns of prescribing psychotropic drugs in nursing homes during the COVID-19 pandemic to those of the pre-pandemic period. METHODS: This cross-sectional multicenter study was conducted in geriatric units and psychogeriatric units in seven nursing homes in Gipuzkoa, Spain. On 1 March, 2020, data regarding 511 residents in geriatric units and 163 in psychogeriatric units were recorded. This study examined utilization percentages for psychotropic drugs before the pandemic (April 2018-March 2020) and during the pandemic (April 2020-March 2021) in light of projected usage based on previous years. Following the Anatomical, Therapeutic, Chemical Classification System, four therapeutic groups were analyzed: antipsychotics (N05A), benzodiazepines (N05B and N05C), antidepressants (N06A), and antiepileptic drugs (N03A). RESULTS: In the case of geriatric units, a downward trend of prescription was reversed for antipsychotics (-0.41; 95% confidence interval [CI] -1.41, 0.60). Benzodiazepine use also decreased less than expected (-2.00; 95% CI -3.00, -1.00). Antidepressant use increased more than predicted (0.02; 95% CI -0.97, 1.01), as did antiepileptic drug use (2.93; 95% CI 2.27, 3.60). In the psychogeriatric units, the drop in antipsychotic utilization was less than expected (-2.31; 95% CI -3.68, -0.93). Although it was expected that the prescription of benzodiazepines would decrease, usage remained roughly the same (-0.28; 95% CI -2.40, 2.34). Utilization of antidepressants (8.57; 95% CI 6.89, 10.24) and antiepileptic drugs (6.10; 95% CI 3.20, 9.00) increased significantly, which was expected, based on the forecast. CONCLUSIONS: For all categories, usage of psychotropic drugs was higher than anticipated based on the forecast; this increase might be related to the worsening of emotional and behavioral disorders caused by the restrictive measures of the COVID-19 pandemic.

Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation.

OBJECTIVE: The goals of this study were to analyze the type of  ntithrombotic treatment administered to institutionalized patients with  nonvalvular atrial fibrillation (and any ensuing complications) and to  evaluate the degree of anticoagulation control achieved with vitamin K  antagonists. Method: This was a prospective observational follow-up study  carried out in seven elderly care facilities during 2016. Patients with  nonvalvular atrial fibrillation were evaluated for their antithrombotic  therapy and any embolic or hemorrhagic events, as well as for mortality.  Subjects on anticoagulation treatment with VKAs were evaluated for  anticoagulation control, with control considered poor if the mean time in  therapeutic range was < 65% when measured with Rosendaal's method or < 60% when determined by the direct method. RESULTS: Of the 699 residents evaluated, 20.6% had a diagnosis of NVAF.  Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2- VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04)  risk were high. Fifty percent received anticoagulation treatment, mainly  with vitamin K antagonists, of whom at least 56% were not within the  therapeutic range. Sixteen percent of the residents, the oldest and most  functionally and cognitively dependent ones, had not been prescribed any  antithrombotic therapy. A higher frequency of hospital admissions induced  by cardiovascular and bleeding events was  found in these residents,  although differences were not statistically significant. CONCLUSIONS: Half of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet  therapy, and some without any antithrombotic treatment. This study  howed that as functionality decreases, treatment strategies are  increasingly aimed at therapeutic deintensification. Given that the degree  of anticoagulation control with vitamin K antagonists is inadequate in 56%  of cases, it is essential to monitor the time in therapeutic range to  optimize treatment as needed.

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes  institucionalizados con fibrilación auricular no valvular y evaluar el grado  de control anticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en  siete centros gerontológicos durante el año 2016, valorando en aquellos  residentes con fibrilación auricular no valvular la terapia antitrombótica  establecida y las incidencias embólicas, hemorrágicas y la mortalidad. En  los residentes anticoagulados con antivitamina K se midió el control de la  anticoagulación, estimándose un mal control si el método de Rosendaal  fuese < 65% o el tiempo en rango terapéutico directo < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían un diagnóstico de fibrilación auricular no valvular, con una edad media de 85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio 4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El  50% estaban anticoagulados, principalmente con antivitamina K, de los  cuales al menos el 56% no se encontraban dentro del rango terapéutico.  Un 16% de los residentes no tenían prescrita terapia antitrombótica,  destacando en éstos una mayor dependencia funcional, cognitiva y edad  más avanzada. Se encontró una mayor frecuencia de ingresos  hospitalarios  de causa cardiovascular y de sangrados en aquellos  residentes anticoagulados, aunque no hubo diferencias significativas.Conclusiones: La mitad de los pacientes geriátricos institucionalizados con fibrilación auricular no valvular están  anticoagulados, un tercio antiagregados y algunos sin tratamiento  antitrombótico, observando que a medida que disminuye la funcionalidad  las estrategias van en la línea de una desintensificación terapéutica. El  grado de control anticoagulante con antivitamina K es inadecuado en el  56% de los casos, por lo que es imprescindible monitorizar el tiempo en  rango terapéutico para optimizar el tratamiento cuando sea necesario.

[Prevalence of prescription of anticholinergic/sedative burden drugs among older people with dementia living in nursing homes]. / Prevalencia de prescripción de fármacos con carga anticolinérgica/sedante en adultos mayores institucionalizados con demencia.

BACKGROUND AND OBJECTIVE: Dementia is one of the most frequent diseases in the elderly, being its prevalence of up to 64% in institutionalized people. In this population, in addition to antidementia drugs, it is common to prescribe drugs with anticholinergic/sedative burden that, due to their adverse effects, could worsen their functionality and cognitive status. The objective is to estimate the prevalence of the use of drugs with anticholinergic/ sedative burden in institutionalized older adults with dementia and to assess the associated factors. MATERIALS AND METHODS: A cross-sectional study developed in older with dementia living in nursing homes. The prevalence of prescription of anticholinergic/sedative drugs was estimated according to the Drug Burden Index (DBI). A comparative analysis of the DBI score was performed between different types of dementia as well as among various factors and according to the anticholinergic/sedative risk, establishing as a cut-off point of DBI≥1 (high anticholinergic/sedative risk). RESULTS: 178 residents were included. 83.7% had some drug with anticholinergic/sedative burden according to DBI. 50% had a DBI≥1 score. Residents with vascular dementia had a mean DBI of 1.34 (SD 0.84), a significantly higher score than residents with Alzheimer's disease (0.41, 95% CI 0.04-0.78).). Likewise, a higher DBI was associated with more polypharmacy (3.36; 95% CI 2.64-4.08), more falls, hospital admissions and emergency room visits (P<.05). CONCLUSIONS: Polypharmacy and prescription of anticholinergic/sedative drugs is frequent among institutionalized older adults with dementia, finding an association between DBI, falls and hospital admissions or emergency department visits. Therefore, it is necessary to propose interdisciplinary pharmacotherapeutic optimization strategies.

Patients in Nursing Homes: type 2 diabetes mellitus prevalence and its pharmacologic therapy.

OBJECTIVE: To determine type 2 diabetes mellitus prevalence, clinical features, specific pharmacologic treatment and problems faced in nursing home patients. METHOD: Observational, cross-sectional study conducted in March 2019  in six nursing homes, examining persons diagnosed with type 2 diabetes mellitus. Demographic, clinical and biochemical variables,  specific pharmacologic therapy and hypoglycemia events as well as falls  during the previous year were collected. RESULTS: Prevalence of type 2 diabetes mellitus was 21.7%. 70.90% of the patients had glycated hemoglobin ≤ 7% last year, with 92% of  the patients having a moderate-severe frailty. 0.4  hypoglycemia/resident-year were found, being more frequent in patients receiving insulinization and in those with impaired renal function.  However, no further falls were found in insulinized patients (p > 0.05).  Diabetes therapy was adequate according to treatment  recommendations for the elderly. CONCLUSIONS: Prevalence of type 2 diabetes is slightly lower than that found in the literature, finding a strict control of the disease and an  appropriate pharmacotherapeutic adequacy according to the  recommendations by the European Diabetes Working Party for Older  People. Insulinized patients and those with impaired renal function have  a higher risk of hypoglycemia.

Objetivo: Determinar la prevalencia de diabetes mellitus tipo 2 y sus características clínicas, tratamiento farmacológico específico y  problemas derivados en personas institucionalizadas en centros  residenciales.Método: Estudio observacional, transversal llevado a cabo en marzo de  2019 en seis centros residenciales en personas con diagnóstico de diabetes mellitus tipo 2. Se recogieron variables demográficas,  clínicas y bioquímicas, tratamiento farmacológico específico y eventos  de hipoglucemia y caídas el año anterior.Resultados: La prevalencia de diabetes mellitus tipo 2 fue del 21,7%. El 70,90% de los pacientes tuvieron una glucohemoglobina ≤  7% el último año, mostrando el 92% de los pacientes una fragilidad  moderada-severa. Se encontraron 0,4 hipoglucemias/residente-año,  siendo más frecuentes en pacientes insulinizados y en aquellos con  función renal deteriorada. Sin embargo, no se encontraron más caídas  en pacientes insulinizados (p > 0,05). El tratamiento de la diabetes fue  adecuado de acuerdo a las recomendaciones de tratamiento en  personas mayores.Conclusiones: Se observa una prevalencia de diabetes tipo 2  ligeramente inferior a lo encontrado en la literatura especializada, con  un control estricto de la enfermedad y una apropiada adecuación  farmacoterapéutica según las recomendaciones de la European Diabetes Working Party for Older People. Los pacientes insulinizados y aquellos  con función renal deteriorada tienen mayor riesgo de hipoglucemia.

[Pharmacological treatment]. / Terapias farmacológicas.

Alzheimer's disease (AD) is a chronic degenerative and inflammatory process leading to synapticdysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made.

[Infection epidemiology in gerontology centres]. / Epidemiología infecciosa en centros gerontológicos.

INTRODUCTION: Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. MATERIAL AND METHODS: A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. RESULTS: The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. CONCLUSIONS: The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures.

Unexplained liver laceration after metastasis radiofrequency ablation.

Many studies have established the role of radiofrequency (RF) ablation as a minimally invasive treatment for liver metastases. Although relatively safe, several complications have been reported with the increased use of RF ablation. We describe here a case of unexplained liver laceration after a RF procedure. A woman who presented a solitary metachronous liver metastasis underwent RF ablation treatment for this lesion. Six hours later the patient displayed fatigue and pallor. Emergency blood tests showed a haemoglobin level of < 7 g/dL and markedly elevated transaminase levels. A computed tomography examination revealed two areas of liver laceration with haematoma, one of them following the path of the needle and the other leading away from the first. Following a blood transfusion, the patient was haemodynamically stable and completely recovered 24 h later. The patient remained in bed for 1 wk. No surgical intervention was required, and she was discharged 1 wk later.