[Clinical characteristics of patients with atrial fibrillation treated with direct oral anticoagulants attended in primary care setting. The SILVER-AP study]. / Perfil clínico de pacientes con fibrilación auricular tratados con anticoagulantes orales de acción directa atendidos en atención primaria. Estudio SILVER-AP.

OBJECTIVE: To analyse the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC). DESIGN: Observational, cross-sectional and multicentre study. LOCATION: Autonomous Communities in which the general practitioner can prescribe DOAC (n=9). PARTICIPANTS: The study included a total of 790 patients on chronic treatment with anticoagulants, and on whom therapy was changed, as well as being currently on treatment with DOAC for at least for 3 months. MAIN MEASURES: A record was made of the sociodemographic and clinical management date. RESULTS: Mean age was 78.6±8.4 years, and 50.5% of patients were men. Mean CHADS2 score was 2.6±1.2, mean CHA2DS2-VASc score was 4.3±1.6, and the mean HAS-BLED score was 2.3±1.0. Mean duration of treatment with DOAC was 15.8±12.5 months. Rivaroxaban was the DOAC most frequently prescribed (57.8%), followed by dabigatran (23.7%), and apixaban (18.5%). Of the patients receiving rivaroxaban, 70.2% were taking the dose of 20mg/daily. Of the patients receiving dabigatran, 41.7% were taking the dose of 150mg twice daily, and in the case of apixaban, 56.2% were taking the dose of 5mg twice daily. Satisfaction (ACTS Burdens scale 52.0±7.2 and ACTS Benefits scale 12.1±2.2), and therapeutic adherence (97.8% of patients took their medication regularly) with DOAC were high. CONCLUSIONS: Patients treated with DOAC in Spain have a high thromboembolic risk. A significant proportion of patients receive a lower dose of DOAC than that recommended according to their clinical profile. Satisfaction and medication adherence are high.

A new classification system for dental treatment under general anesthesia.

The provision of comprehensive care for patients with special needs using dental general anesthesia (DGA) has changed over time, and now includes more complex procedures and the participation of many services. As a result, it is necessary to integrate, organize and describe all of the procedures that are carried out in different DGA settings. The aim of this study was to propose a systematic classification for dental treatment procedures be delivered under DGA, and to compare this classification system with an existing system. This new classification system has three distinct components: type, frequency and length of time needed to complete dental procedures for both primary and permanent teeth. A wide range of oral surgery procedures and endodontic treatment was also included. A retrospective cohort study utilizing 84 subjects was used to develop and compare the two classification systems. When comparing the different categories of procedures by both classifications, there were significant statistical differences between them (p < 0.05). Oral health care for patients with special needs has evolved, with more complex and extensive interventions that require teamwork by personnel from different dental or medical specialties. The classification system in this study includes detailed information regarding the procedures involved in the DGA. This helps to provide a clear understanding and specific information that enables the comparison of clinical experiences across populations where a DGA has been used for patients with special needs.

Single-dose ebselen does not afford sustained neuroprotection to rats subjected to severe focal cerebral ischemia.

Oxygen free radicals have been involved in the pathophysiology of cerebral ischemia, especially after spontaneous or thrombolytic reperfusion. In this study with rats, we have combined a severe focal ischemic insult (2 h) and a prolonged reperfusion time (7 days) to assess the possible sustained neuroprotective effect of ebselen (10 or 100 mg/kg), a small, lipophilic organoselenium compound which mimics glutathione peroxidase. Parietal cortical perfusion was measured by laser-Doppler flowmetry, and focal cerebral ischemia was carried out by the intraluminal thread method. We have measured plasma selenium levels, brain reduced glutathione levels, as a marker of oxidative stress, and infarct volume associated with cerebral ischemia. Focal ischemia did not alter reduced glutathione levels, while 60 min reperfusion following ischemia induced a significant (P < 0.05) decrease in reduced glutathione levels of the ipsilateral hemisphere. Pretreatment with ebselen, which induced significant (P < 0.05) increase in plasma selenium levels, did not significantly alter the decrease in reduced glutathione levels. The ischemic insult induced 30% mortality on average, with deaths always occurring within 12-48 h. Surviving rats suffered up to 25% body weight loss 1 week after the ischemic insult. Infarct volumes were 26.8 +/- 4.7% of the hemisphere in placebo-treated rats, 26.6 +/- 3.6% in 10 mg/kg ebselen-treated rats, and 25.6 +/- 6.4% in 100 mg/kg ebselen-treated rats (not significantly different). Single-dose administration of ebselen does not reduce the size of brain infarct resulting from severe focal cerebral ischemia in rats. In contrast to previous studies with relatively earlier endpoints, we have delayed the measurement of infarct volume to 1 week after the ischemic insult.