A modifiable factors-based model for detecting inactive individuals: are the European assessment tools fit for purpose?

BACKGROUND: The lack of systematic factors affecting physical inactivity (PIA) challenges policymakers to implement evidence-based solutions at a population level. The study utilizes the Eurobarometer to analyse PIA-modifiable variables. METHODS: Special Eurobarometer 412 physical activity (PA) data were analysed (n = 18 336), including 40 variables along with the International PA Questionnaire. PIA was used as the dependent variable. Variables considered were alternatives to car, places, reasons and barriers to engaging in PA, memberships to clubs and categorical responses about the agreement extent with the area, provision of activities and local governance statements. Logistic regression was used to identify variables contributing to PIA. Beta values (ß), standard errors, 95% confidence intervals, the exponentiation for odds ratio and Cox & Snell and Nagelkerke R2 were indicated. RESULTS: The resulting model correctly identified 10.7% inactives and 96.9% of actives (R2 of Nagelkerke: 0.153). Variables contributing to the detection of PIA were (P ≤ 0.01): having a disability or an illness, not having friends to do sport with, lacking motivation or interest in and being afraid of injury risk. Additionally, totally agreeing, tend to agree and tend to disagree regarding the extent of local providers offering enough opportunities to be more active also contributed to the model. CONCLUSIONS: The model reported a limited ability to detect modifiable factors affecting PIA, identifying a small percentage of inactive individuals correctly. New questions focused on understanding inactive behaviour are needed to support the European PA public health agenda.

Assessment of the quality of antibiotics prescription in a regional health system. / Evaluación de la calidad de la prescripción de antibióticos en un sistema regional de salud.

OBJECTIVES: The inappropriate and indiscriminate use of antibiotics is one of the main factors contributing to the onset of antimicrobial resistance. In 2007, the European Surveillance of Antimicrobial Consumption (ESAC) project established certain indicators to assess the quality of antibiotic use. We analysed the quality of antibiotic prescription in La Rioja (Spain) in 2017, using epidemiological (age, sex, seasonal nature) and financial variables (price of the antibiotic and income level). MATERIAL AND METHODS: Using data on monthly distributions of antibiotics (J01) through official prescriptions and prescriptions from medical insurance companies, we calculated the population rates for the number of prescriptions per 1000 inhabitants, as well as the values of 9 quality indicators (by antibiotic family, age group, sex and income), defined by ESAC, classifying the prescription quality as "very high", "high", "low" and "very low". RESULTS: The quality of antibiotic prescriptions in La Rioja in 2017 was "high" for antibiotics dispensed through official prescriptions (18.55 daily defined doses per 1000 inhabitants [DID]) and "low" for those dispensed through medical insurance companies (21.79 DID). When we included private prescriptions (26.02 DID), the quality was "very low", taking into account the margins indicated by ESAC. We detected high rates of prescription for broad-spectrum antibiotics for men older than 45 years, penicillins for women aged 25 to 39 years, quinolones for pensioners and cephalosporins for high-income patients. CONCLUSIONS: The quality of antibiotic prescription is determined not only by epidemiological variables, such as age and sex, but also by financial variables, such as patient income and antibiotic price.

The active living gender's gap challenge: 2013-2017 Eurobarometers physical inactivity data show constant higher prevalence in women with no progress towards global reduction goals.

BACKGROUND: The World Health Organization (WHO) considers physical inactivity (PIA) as a critical noncommunicable factor for disease and mortality, affecting more women than men. In 2013, the WHO set a 10% reduction of the PIA prevalence, with the goal to be reached by 2025. Changes in the 2013-2017 period of physical inactivity prevalence in the 28 European Union (EU) countries were evaluated to track the progress in achieving WHO 2025 target. METHODS: In 2013 and 2017 EU Special Eurobarometers, the physical activity levels reported by the International Physical Activity Questionnaire of 53,607 adults were analyzed. Data were considered as a whole sample and country-by-country. A χ2 test was used to analyze the physical inactivity prevalence (%) between countries, analyzing women and men together and separately. Additionally, PIA prevalence was analyzed between years (2013-2017) for the overall EU sample and within-country using a Z-Score for two population proportions. RESULTS: The PIA prevalence increased between 2013 and 2017 for the overall EU sample (p <  0.001), and for women (p = 0.04) and men (p < 0.001) separately. Data showed a higher PIA prevalence in women versus men during both years (p <  0.001). When separately considering changes in PIA by gender, only Belgium's women and Luxembourg's men showed a reduction in PIA prevalence. Increases in PIA prevalence over time were observed in women from Austria, Croatia, Germany, Lithuania, Malta, Portugal, Romania, and Slovakia and in men from Bulgaria, Croatia, Czechia, Germany, Italy, Lithuania, Portugal, Romania, Slovakia, and Spain. CONCLUSIONS: PIA prevalence showed an overall increase across the EU and for both women and men between 2013 and 2017, with higher rates of PIA reported for women versus men during both years. PIA prevalence was reduced in only Belgium's women and Luxembourg's men. Our data indicate a limited gender-sensible approach while tacking PIA prevalence with no progress reaching global voluntary reductions of PIA for 2025.

A retrospective analysis of policy development on compliance with World Health Organization's physical activity recommendations between 2002 and 2005 in European Union adults: closing the gap between research and policy.

BACKGROUND: Physical inactivity (PIA) is a mortality risk factor defined as performing lower levels of physical activity than recommended by the World Health Organization (WHO). After 2002, the WHO released the WHA55.23 Resolution and the Global Strategy which produced several changes in policymaking, but with no subsequent analyses of the impact of these changes in European Union (EU) policymaking while examining PIA prevalence. METHODS: PIA of 31,946 adults as a whole sample and country-by-country were analyzed in the 2002 and 2005 EU Special Eurobarometers. PIA prevalence between countries was performed with the χ2 test and PIA between both years and between genders was analyzed with the Z-Score test for two population proportions. A retrospective analysis of national plans was performed to interpret the suitability of such policy documents, considering changes in PIA prevalence. RESULTS: Differences in PIA prevalence were observed between countries (p <  0.001) and years (p <  0.001) for the whole sample and men and women separately. Within-country samples showed no differences for Denmark, Finland, Ireland, Italy, Luxemburg, Portugal, and Spain (p > 0.05). When considering gender, there were no gender reductions in subsamples for Denmark, Finland, Ireland, Portugal, Spain, and United Kingdom, neither in Luxemburg for men, nor in France and Italy for women. When analyzing gender differences across the entire sample, PIA was higher in women than men for both years (p <  0.001). Greece and Luxemburg did not release national plans for promoting physical activity. CONCLUSIONS: While large differences in PIA prevalence between EU countries prevailed, the overall PIA descended between both years for the whole sample, men, and women. While this points out a general suitability of policymaking for reducing PIA, not all countries reported reductions in PIA for men, women, or both genders. Also, PIA levels were higher for women in both years, suggesting a less than optimal policy implementation, or lack of women-specific focus across the EU. This analysis helps to identify the strengths and weaknesses of PIA policymaking in the EU and provides researchers with targeted intervention areas for future development.

An evaluation of an immunomodulatory feed ingredient in heat-stressed lactating Holstein cows: Effects on hormonal, physiological, and production responses.

Holstein cows (n = 30) were balanced by days in milk, milk production, and parity (91 ± 5.9 d in milk, 36.2 ± 2.5 kg/d, and 3.1 ± 1.4, respectively) and fed OmniGen-AF (OG; Phibro Animal Health, Teaneck, NJ), an immune stimulant, at 0 g/cow per d for control (CON) or 56 g/cow per d for OG for 52 d on a commercial dairy. At 52 d of the study cows were randomly selected (n = 12) from both groups (6 OG and 6 CON) and housed in environmentally controlled rooms at the Agricultural Research Complex for 21 d at the University of Arizona. Cows were subjected to 7 d of thermoneutral (TN) conditions, 10 d of heat stress (HS), and 4 d of recovery (REC) under TN conditions. Feed intake, milk production, and milk composition were measured daily. Rectal temperatures (RT) and respiration rates (RR) were recorded 3 times per day (600, 1400, and 1800 h). Blood samples were taken on d 7 (TN), 8 (HS), 10 (HS), 17 (HS), and 18 (TN) during the Agricultural Research Complex segment. Cows in HS had higher RR and RT and water intake and lower dry matter intake and milk yield than these measures in TN. There was a treatment × environment interaction with cows fed OG having lower RR and RT and higher dry matter intake during peak thermal loads than CON. However, milk yield did not differ between groups. Cows fed OG had lower milk fat percent than CON (3.7 vs 4.3%) during HS. The SCC content of milk did not differ between treatment groups but rose in both groups during the REC phase following HS. Plasma insulin and plasma glucose levels were not different between groups. However, plasma insulin in both groups was lower during acute HS, then rose across the HS period, and was highest during the REC phase. Plasma cortisol levels were highest in all cows on the first day of HS (d 8) but were lower in cows fed OG compared with CON. However, plasma ACTH concentrations were elevated in OG-fed animals at all times samples were collected. Plasma ACTH was also elevated in cows fed both OG and CON during HS. Feeding OG reduced plasma cortisol during acute but not chronic HS and increased basal plasma ACTH, suggesting that OG treatment may alter the hypothalamic pituitary adrenal axis.

A comparison of 2 evaporative cooling systems on a commercial dairy farm in Saudi Arabia.

Efficacy of 2 cooling systems (Korral Kool, KK, Korral Kool Inc., Mesa, AZ; FlipFan dairy system, FF, Schaefer Ventilation Equipment LLC, Sauk Rapids, MN) was estimated utilizing 400 multiparous Holstein dairy cows randomly assigned to 1 of 4 cooled California-style shade pens (2 shade pens per cooling system). Each shaded pen contained 100 cows (days in milk=58±39, milk production=56±18 kg/d, and lactation=3±1). Production data (milk yield and reproductive performance) were collected during 3mo (June-August, 2013) and physiological responses (core body temperature, respiration rates, surface temperatures, and resting time) were measured in June and July to estimate responses of cows to the 2 different cooling systems. Water and electricity consumption were recorded for each system. Cows in the KK system displayed slightly lower respiration rates in the month of June and lower surface temperatures in June and July. However, no differences were observed in the core body temperature of cows, resting time, feed intake, milk yield, services/cow, and conception rate between systems. The FF system used less water and electricity during this study. In conclusion, both cooling systems (KK and FF) were effective in mitigating the negative effects of heat stress on cows housed in arid environments, whereas the FF system consumed less water and electricity and did not require use of curtains on the shade structure.

Air pollution and health prevention: A document of reflection.

Ambient air quality, pollution and its implication on health is a topic of enormous importance that is normally dealt with by major specialists in their particular areas of interest. In general, it is not discussed from multidisciplinary approaches or with a language that can reach everyone. For this reason, the Health Sciences Foundation, from its prevention area, has formulated a series of questions to people with very varied competences in the area of ambient air quality in order to obtain a global panorama of the problem and its elements of measurement and control. The answers have been produced by specialists in each subject and have been subjected to a general discussion that has allowed conclusions to be reached on each point. The subject was divided into three main blocks: external ambient air, internal ambient air, mainly in the workplace, and hospital ambient air and the consequences of its poor control. Along with the definitions of each area and the indicators of good and bad quality, some necessary solutions have been pointed out. We have tried to know the current legislation on this problem and the competences of the different administrations on it. Despite its enormous importance, ambient air quality and health is not usually a topic of frequent presence in the general media and we have asked about the causes of this. Finally, the paper addresses a series of reflections from the perspective of ethics and very particularly in the light of the events that the present pandemic raises. This work aims to provide objective data and opinions that will enable non-specialists in the field to gain a better understanding of this worrying reality.

Assessment of the quality of antibiotics prescription in a regional health system.

OBJECTIVES: The inappropriate and indiscriminate use of antibiotics is one of the main factors contributing to the onset of antimicrobial resistance. In 2007, the European Surveillance of Antimicrobial Consumption (ESAC) project established certain indicators to assess the quality of antibiotic use. We analysed the quality of antibiotic prescription in La Rioja (Spain) in 2017, using epidemiological (age, sex, seasonal nature) and financial variables (price of the antibiotic and income level). MATERIAL AND METHODS: Using data on monthly distributions of antibiotics (J01) through official prescriptions and prescriptions from medical insurance companies, we calculated the population rates for the number of prescriptions per 1000 inhabitants, as well as the values of 9 quality indicators (by antibiotic family, age group, sex and income), defined by ESAC, classifying the prescription quality as "very high", "high", "low" and "very low". RESULTS: The quality of antibiotic prescriptions in La Rioja in 2017 was "high" for antibiotics dispensed through official prescriptions (18.55 daily defined doses per 1000 inhabitants [DID]) and "low" for those dispensed through medical insurance companies (21.79 DID). When we included private prescriptions (26.02 DID), the quality was "very low", taking into account the margins indicated by ESAC. We detected high rates of prescription for broad-spectrum antibiotics for men older than 45 years, penicillins for women aged 25 to 39 years, quinolones for pensioners and cephalosporins for high-income patients. CONCLUSIONS: The quality of antibiotic prescription is determined not only by epidemiological variables, such as age and sex, but also by financial variables, such as patient income and antibiotic price.

Intraindividual Characterization of the Sleep Spindle Variability in Healthy Subjects.

Spatial and frequency characterization of sleep spindles have been extensively addressed using M/EEG or fMRI recordings. However, its intraindividual variability across time has not been addressed. Here we propose to assess the intraindividual variability of sleep spindles in a time-resolved way by means of a trial-to-trial-variability (TTV) measure. For that purpose, the EEG of 26 healthy subjects were recorded overnight. After an exhaustive preprocessing pipeline to remove artifacts, spindles were automatically detected using a complex demodulation-based method. Then, the Wavelet Scalogram was estimated to validate it. Spindle TTV of each participant was also computed for all the conventional EEG frequency bands. Root mean square (RMS) of each TTV signal was calculated as a measure of the total variability of each spindle. Results showed significant differences in the variability between frequencies. Specifically, RMS in the beta-1 frequency band showed higher values as compared to all the other frequency bands (p<0.001). TTV curves showed a dichotomic trend, with lower frequencies showing an increase in the variability before the spindle onset, and higher frequencies showing such increase after the onset. The dependence of the spindle variability with the frequency could be explained by the influence of the multiple cortical generators involved.Clinical Relevance- Sleep spindles are similarly affected in different cognitive-related disorders, which supports the relevance of assessing abnormal sleep patterns as a possible cause for such cognitive deficits.

Clinical relevance of constant power exercise duration changes in COPD.

The endurance time during constant high work-rate exercise (t(LIM)) is used to assess exercise capacity in patients with chronic obstructive pulmonary disease and as an outcome measure for pulmonary rehabilitation. Our study was designed to establish the minimum clinically important difference for the t(LIM). t(LIM) was measured in 105 patients (86 males) before and after an 8-week outpatient pulmonary rehabilitation programme. Subjects were asked to identify, from a five-point Likert scale, the perceived change in their exercise performance immediately upon completion of the exercise tests. The scale ranged from "better" to "worse". The mean+/-sd age was 64+/-5 yrs, forced expiratory volume in 1 s (FEV(1)) 47+/-10% and FEV(1)/forced vital capacity 54.7+/-16.3%. Baseline t(LIM) at 75% of the peak work rate was 397+/-184 s, which increased by 62+/-63% after rehabilitation. In subjects who felt their exercise tolerance was "slightly better", the mean improvement was 34% in the relative improvement over the baseline value (95% CI 29-39)% or 101 (86-116) s compared with 121 (109-134)% in those who reported that their exercise tolerance was "better" and 8 (2-14)% in those who felt their exercise tolerance was "about the same". Minimum clinically important improvement for t(LIM) averaged approximately 33% of baseline. Patients were able to distinguish at least one further additional level of benefit at 120% of baseline.

[Acute renal failure in a young male with cellulitis in the lower leg]. / Fallo renal agudo en varón joven con celulitis en extremidad inferior.

Necrotizing fascitiis due to Streptococcus Pyogenes has a high mortality rate. Detection of the infection before it developes to the streptococcal toxic shock syndrome is quite challenging and its one of the main goals of its management because at this final stage the treatment is in most of the cases ineffective. In a secuence of events of the progression of the infection to shock, renal failure occurs before hipotension very often. We report the case of a 38-year-old patient affected by a fulminant necrotizing fascitiis by Streptococcus Pyogenes which presented at admission with lower leg cellulitis and acute renal failure.

Treatment of postoperative pain for burn patients with intravenous analgesia in continuous perfusion using elastomeric infusors.

INTRODUCTION: Postoperative pain after surgery with patients suffering from burns tends to be moderate or severe, and its treatment requires a combination of high-strength analgesics (opioids) with others having different action mechanisms according to the concept of multimodal analgesia. AIMS: In this article we propose the use of continuous intravenous analgesia with morphine using elastomeric infusors at fixed dose for the treatment of this kind of pain. An evaluation is made of its analgesic efficacy, side effects and level of satisfaction. MATERIAL AND METHODS: A study was made of 17 burn patients operated on in our unit who received continuous intravenous analgesia during the postoperative period, with morphine at 1mg/h, using elastomeric infusors for a period of 24h. Its analgesic efficacy was analysed using the visual analogical scale (VAS) at different moments; side effects and the level of acceptance by the patient was also evaluated. RESULTS: The results confirm a good analgesic effect after 2h from starting perfusion (VAS < 3). The side effects reveal a similar or lesser incidence to the use of morphine in bolus or using the PCA system, and in no cases did they require treatment to be halted. The level of acceptance of the procedure by patients was good. CONCLUSION: This method reveals a high level of analgesic efficacy in the postoperative period with burn patients in this study. However, it is important to note the lower results obtained in the first hours of perfusion, and proposing a heavy initial dose of analgesics when starting perfusion. This is presented as an efficient analgesic method that is easy to apply, has a low cost, and the possibility of extending its indications to ambulatory treatment.

Effects of electrical stimulation on wound healing in patients with diabetic ulcers.

OBJECTIVE: To evaluate the effects of two stimulation waveforms on healing rates in patients with diabetes and open ulcers. The hypothesis was that stimulus waveforms with minimal polar characteristics would provide significant healing for this patient sample. RESEARCH DESIGN AND METHODS: This was a prospective study that enrolled 80 patients with open ulcers. Patients received stimulation with either an asymmetric biphasic (A) or symmetric biphasic (B) square-wave pulse. Amplitudes were set to activate intact peripheral nerves in the skin. Two other groups received either very low levels of stimulation current (MC), or no electrical stimulation (C). When combined these groups were referred to as the control group. Treatment was carried out daily until the wound healed, the patient withdrew from the study, or the physician changed the overall wound management program. Average healing rates were calculated from weekly measures of the wound perimeter and were used for statistical comparison through a one-way analysis of variance. RESULTS: Stimulation with the A protocol significantly increased the healing rate, enhancing healing by nearly 60% over the control rate of healing. Stimulation with the B protocol did not increase the healing rate when compared with control subjects. CONCLUSIONS: Electrical stimulation, given daily with a short pulsed, asymmetric biphasic waveform, was effective for enhancement of healing rates for patients with diabetes and open ulcers.

Evaluation of the TriSpan neck bridge device for the treatment of wide-necked aneurysms: an experimental study in canines.

BACKGROUND AND PURPOSE: Many wide-necked aneurysms are difficult or impossible to treat with the Guglielmi detachable coil (GDC). The purpose of this study was to evaluate the use of a neck bridging device, the TriSpan coil, in combination with standard GDCs for the treatment of wide-necked aneurysms in an experimental canine aneurysm model. METHODS: Of 24 experimental aneurysms in 12 animals, 19 (7 lateral and 12 terminal) were treated with the TriSpan coil in conjunction with standard GDCs. Digital subtraction angiography (DSA) was performed on all animals immediately after treatment. In 6 animals, follow-up DSA and histological evaluation were performed 4 weeks after treatment. In the remaining 6, DSA was done at both 90 and 180 days after treatment. Histological evaluation was done immediately after the 180-day angiographic evaluation. RESULTS: The TriSpan was easy to use in conjunction with the standard GDC. Because of their geometry, some lateral aneurysms were difficult or impossible to treat with this device. Greater than 90% aneurysm occlusion was obtained in all 19 aneurysms. In no instance was there evidence of coil migration, herniation, or aneurysm recanalization. Histological evaluation of the tissue surrounding the TriSpan coil showed tissue responses similar to that seen with standard GDCs. CONCLUSIONS: These results show that the TriSpan coil in conjunction with standard GDCs can be used safely and effectively for the treatment of wide-necked aneurysms in this canine model. Positioning and deployment of the neck bridge in aneurysms having an acute angle with the long axis of their parent artery are difficult or impossible. It is likely that this device, used in conjunction with the standard GDC, will allow treatment of some wide-necked aneurysms that are not treatable with the GDC alone.

Adult men born in spring have lower blood pressure.

OBJECTIVE: To determine whether there is a relationship between season of birth and adult blood pressure, as a possible early determinant of later blood pressure. DESIGN: We studied 572 men, aged 45-64 years, whose blood pressure was measured in standardized manner as part of a nation-wide survey in Spain. To analyse the seasonal variation in blood pressure, a linear regression was performed, adjusting for age, height, body mass index, occupation and rural or urban residence. RESULTS: We found seasonal variation in mean systolic blood pressure, with maxima in adults born in autumn and winter, and minima in those born in spring and summer. The greatest difference in systolic blood pressure occurred between adults born in spring (134.1 mmHg) and those born in autumn (140.3 mmHg). After adjustment, the difference in means between spring and autumn was 5.9 mmHg (95% confidence interval 0.7 to 11.1 mmHg, P = 0.03). CONCLUSIONS: This study demonstrated differences in systolic blood pressures of adult men according to the season of their birth. Although this relationship is compatible with several hypotheses, the difference found between spring and autumn, partially independent of some other factors, might indicate that the extent of early exposure to sunlight is implicated in determining later blood pressure. This needs further investigation.

Modulation of long-term synaptic plasticity at excitatory striatal synapses.

Modulation of long-term plasticity by both the intrinsic activation of metabotropic glutamate receptors and dopamine released from the nigrostriatal pathway was investigated at excitatory striatal synapses. Intracellular recordings demonstrated that tetanic stimulation at an intensity equal to that used for synaptic sampling produced, on average, a slight long-term depression of excitatory postsynaptic potentials. The long-term response pattern was variable, however, with some cells showing potentiation and others no plasticity. Block of metabotropic glutamate receptors with 3-aminophosphonovaleric acid changed the pattern of responses, increasing the percentage of cells showing long-term potentiation. Similarly, 6-hydroxydopamine lesions to the substantia nigra changed the pattern of response to tetanic stimulation, increasing the expression of long-term potentiation. These data indicate that metabotropic glutamate receptor and dopamine receptor activation may function to regulate the expression of activity-dependent plasticity at corticostriatial synapses. Paired-pulse stimulation revealed that post-tetanic plasticity was negatively correlated with changes in paired-pulse plasticity in the control and 6-hydroxydopamine-lesioned groups, suggesting that the expression of long-term plasticity has a presynaptic component at corticostriatal synapses.

Mortality attributable to cardiovascular risk factors in Spain.

OBJECTIVE: To present the current burden of mortality attributable to some of the main cardiovascular risk factors in adults in Spain. METHODS: Mortality attributable to risk factors was calculated by combining their prevalence, the relative risks for death, and the number of deaths in Spain. Prevalence of hypertension (>/=140/90 mmHg), tobacco smoking, excess weight (body mass index >/=25 kg/m(2)), and self-reported diabetes were based on representative samples of the Spanish population in the 1990s. The relative risks came from valid international studies. RESULTS: About 14 000 total deaths (25% of all deaths) were attributable to hypertension in Spain's middle-aged population. A quarter of them were cardiovascular deaths. About 56 000 deaths were attributable to tobacco use in adults >/=35 y (16% of all deaths). Two-thirds of them were deaths for: lung cancer (26.5%), chronic obstructive pulmonary disease (20.9%), coronary heart disease (12.8%), and stroke (9.2%). About 28 000 deaths (8.5% of all deaths) were attributable to excess weight in adults. Two-thirds of them were cardiovascular deaths. About 2800 cardiovascular deaths were attributable to diabetes in adults >/=35 y (6% of all cardiovascular deaths). CONCLUSIONS: Mortality attributable to the risk factors studied is a major avoidable public health problem in Spain. The results presented are only illustrative but clearly show that there is considerable scope for prevention.

Acute colonic pseudo-obstruction in a burn patient.

Acute colonic pseudo-obstruction as a syndrome was first described by Ogilvie in 1948 (Br. Med J. 2, 671). It is characterized by colonic dilatation with no mechanical cause which affects critically ill patients. As a result of this complication the prognosis worsens. Initially there are few clinical symptoms, but subsequently colonic obstruction develops which, if not treated, can cause perforation of the caecum resulting in a high mortality rate. The treatment includes decompression via rectal and nasogastric probes, colonoscopy and caecostomy.

[Economic evaluation of eptifibatide]. / Evaluación económica de eptifibatide.

INTRODUCTION AND OBJECTIVES: The aim of this study was to perform an economic evaluation of the PURSUIT trial in Spain, and to measure the cost per year of life saved in patients treated with this drug. PURSUIT is a large, randomised multicentric study on the treatment of unstable angina or non Q wave myocardial infarction with eptifibatide versus placebo, METHODS: The data on resource consumption provided by the PURSUIT trial were grouped in several populations according to geographical and resource consumption criteria. Unitary costs of these resources were calculated using an "upward" approach that combines individual costs to obtain total costs of several processes and lengths of hospital stay. Cost analysis compares the costs of the initial admission and of the following six months (total cost per patient) for both placebo and eptifibatide. Cost-effectiveness analysis is calculated from total costs and years of life saved calculated according to projections made from results of PURSUIT for Western Europe. RESULTS: The average 6 month cost for the patients who received placebo varies from 0.91 to 1.41 million pesetas, and from 0.96 to 1.45 million pesetas for those treated with eptifibatide. The mean survival was 16.07 years in the placebo group versus 16.11 years in eptifibatide group; 2.9 years of life were saved for every 100 patients treated. The incremental cost of each year of life saved ranges from 1.3 to 3.3 million pesetas. CONCLUSIONS: Results vary depending on resource consumption data used. The cost per year of life saved is within the limits considered acceptable for a new technology.

[Intrahepatic portocaval shunt: review of the literature, apropos of 1 case]. / Shunt porto-cave intra-hépatique. Revue de la littérature, à propos d'un cas.

We report a case of portal-hepatic shunt which was detected fortuitously by ultrasonography in a 66-year-old patient. This abnormality, mainly described in cirrhotic liver and rarely in healthy liver, is usually revealed by hepatic encephalopathy or glycoregulation disorders. We propose a diagnostic and therapeutic approach based on a review of the literature.