Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos / Humanization in healthcare arises from the need for a holistic approach to illness

La humanización en sanidad surge por la necesidad de acercarnos a una dimensión más holística de la enfermedad. El sufrimiento no solo es exclusivo de los pacientes y las familias, sino que el profesional se encuentra en el centro del proceso de despersonalización. El exceso de tecnificación y la colocación del proceso patológico en ocasiones como único objetivo de actuación, así como la hipertrofia del poder institucional que estamos viviendo en los últimos tiempos, hacen que en ocasiones el propio profesional sanitario sea el primero en demandar un cambio en el abordaje de la dinámica dentro de las instituciones sanitarias. Tras una reflexión inicial, desde el corazón de la medicina más tecnificada, como es la Medicina Intensiva, clásicamente aislada del resto del entorno hospitalario y de las familias, decidimos abordar un proyecto de integración, empatía y acercamiento a los pacientes y familiares de la Unidad de Cuidados Intensivos (UCI) del Hospital Infanta Margarita, en el que se pretendieron implementar herramientas para trabajar en los elementos más importantes de un plan de humanización (las familias, pacientes, profesionales, y nuestra comunidad), potenciando el dar a conocer el trabajo que se realiza en la UCI y que se desarrolló a lo largo de 12 meses, el proyecto: UCI Infanta Margarita, 1 año: 12 meses para 12 compromisos (AU)

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments (AU)

Update on the management of vasoproliferative tumour. / Actualización sobre el manejo del tumor vasoproliferativo.

CASE REPORT: Here we report a 19-year-old female patient who presented a vasoproliferative tumour. It caused complications, such as epiretinal membrane, macular oedema, vitreous haemorrhage, and exudative retinal detachment. The patient was treated with 3 injections of intravitreal bevacizumab, an intravitreal dexamethasone implant, tocilizumab, and double freeze-thaw cryotherapy. DISCUSSION: Therapeutic options are: observation, if it is small, if it is a peripheral lesion, and if there seems to be no threat to vision. If it requires treatment, laser photocoagulation, intravitreal bevacizumab, trans-conjunctival cryotherapy, transpupillary thermotherapy, photodynamic therapy, brachytherapy plaques and surgery are the different options available. Recently, tocilizumab and intravitreal dexamethasone implants have been reported to be beneficial.

Humanization in healthcare arises from the need for a holistic approach to illness. / Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos.

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

Dolicomegacolon chagásico / Chagasic dolicho-megacolon

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Ricinus communis and Jatropha curcas (Euphorbiaceae) seed oil toxicity against Atta sexdens rubropilosa (Hymenoptera: Formicidae).

Leaf-cutting ants are the main herbivores in the New World tropics. Although the toxicity of seed oils against these ants has been poorly investigated, previous results revealed that seed oils exert considerable toxic activity against these insects. This paper analyzes the toxic action and deterrent properties of castor oil, Ricinus communis L., and physic nut oil, Jatropha curcas L., against workers of the leaf-cutting ant Atta sexdens rubropilosa reared in laboratory. Toxic effect was analyzed by feeding insects artificial diets supplemented with different oil concentrations and direct contact with the two oils. Deterrent activity was assessed by measuring the frequency of attendance to diets during the first 48 h of the ingestion bioassay. Castor oil at 10 and 30 mg/ml and physic nut oil at 5, 10, and 30 mg/ml were toxic by ingestion. In the direct contact bioassay, toxicity was observed for physic nut oil at 0.1 and 0.2 mg/ml, whereas castor oil exerted toxic effects only when the highest concentration was applied. Also, castor oil had a more pronounced deterrent effect against the leaf-cutting ant, compared with physic nut oil. Methods to apply these oils to control these insects are discussed.

Cardoon allergy

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Influence of sodium glycocholate on production of conjugated linoleic acid by cells of Lactobacillus reuteri ATCC 55739.

The possible influence of a bile salt on production of conjugated linoleic acid (CLA) by Lactobacillus reuteri ATCC 55739 was evaluated. Cells of the lactobacilli grown in MRS broth with and without linoleic acid (LA, 0.2%) were harvested and washed. The washed cells were added to buffer containing 0.2% LA and incubated 18 h at 37 degrees C. The cells, which had been grown without LA, transformed LA into CLA (mainly c9t11-C18:2) better than did those cells grown with it. When sodium glycocholate (0.3%) was added to the washed cell suspensions, about the same level of CLA was formed as in its absence regardless of whether or not the cells had been grown in broth supplemented with free LA. Thus, glycocholate that occurs in humans did not influence production of CLA by resting cells of the lactobacilli.

Allergens from rye pollen (Secale cereale). I. Study of protein release by rye pollen during a 19-hour extraction process. Allergen identification.

We have studied the proteins and allergens released by rye pollen in the course of a 19-h pollen incubation process. Nearly 40% of the total extracted proteins were collected during the first 5 min, and most of them had a molecular weight less than 28 kDa. Between 5 and 30 min, 15% of the proteins from total extract were released, showing in the SDS-PAGE analysis an increase in which components moved close to 30 kDa standard. From 30 min to 19 h several extracts were collected. Electrophoretical profile of components from these extracts reveals that bands moving below 28 kDa were practically absent and those of 28 and 23 kDa became very intense. At the end of the process there was a rise of 67 kDa proteins. Dot-immunobinding and immunoblotting techniques reveal that allergens leave the rye pollen, for the most part, after 5 min incubation and are proteins with 28 kDa, 33 kDa, 48 kDa and 67 kDa molecular weights.

Allergens from rye pollen (Secale cereale). II. Characterization and partial purification.

Rye pollen was incubated for 30 min and proteins extracted at this time were collected as extract A (EA). The same pollen grains were resuspended in buffer and incubated for 18.5 h. Proteins extracted in this period were designated extract B (EB). Both extracts were subfractionated by DEAE ion-exchange chromatography and allergen presence in peaks detected by the dot-immunobinding technique. The results reveal that unretained proteins (peaks 1 and 2) and proteins eluted at 0.2 M NaCl from extract B contain the highest proportion of allergens. SDS-PAGE of chromatographic peaks showed that peak 2 from extract B contains a highly purified 28 kDa band. On the skin of allergic patients this band gave a stronger positive prick test than for the crude extract.

Bakers' asthma: prevalence and evaluation of immunotherapy with a wheat flour extract.

One hundred thirty-nine bakers and pastry cooks were included in a prevalence study of IgE-mediated hypersensitivity to wheat flour demonstrated by skin tests, specific IgE to wheat flour (RAST), and inhalation challenge. From the sensitized workers, we selected 30 asthmatic patients. Twenty patients were treated with a standardized wheat flour extract, and ten with a placebo in a double-blind clinical trial. Before and after immunotherapy we performed tests in vivo (skin tests with wheat flour and methacholine tests), and in vitro (total IgE and specific IgE to wheat flour). We found substantial prevalence of wheat flour allergy (25.17% of workers), and a significant decrease (P less than .001) in hyperresponsiveness to methacholine, skin sensitivity (P = .002), and specific IgE (P less than .005) to wheat flour after 20 months of immunotherapy. There was also significant subjective improvement (P less than .001). The placebo group showed no changes in these variables.