Oral cancer awareness in North-Western Spain: a population-based study.

BACKGROUND: An early diagnosis depends greatly on patient awareness. Thus, the aim of this study was to investigate general awareness of oral cancer and knowledge about its risk factors, signs and symptoms. MATERIAL AND METHODS: Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS: A total of 5,727 people entered the survey (response rate: 53%). When asked what cancers participants had heard about, 20.3% mentioned oral cancer. Regarding risk factors, tobacco was mentioned by 55.3% of the sample (n=3,169), followed by alcohol (12.5%; n=708), poor oral hygiene (10.8%; n=618), diet (6.5%; n=377), and genetics (4.5%; n=248). CONCLUSIONS: General population has low awareness of oral cancer with poor knowledge of risk factors and main alarm signs. In addition, individuals in the risk group scored lower values in the main variables analysed; even those highly educated showed insufficient awareness and knowledge of oral cancer. In these circumstances, there is clear need for educational interventions tailored to the target audience and aimed at increasing knowledge and awareness of oral cancer to promote primary prevention of oral cancer and minimising the time interval of patients with symptomatic oral cancer in their path to treatment.

Online audio-visual information on oral cancer for Spanish-speaking laypersons. A cross-sectional study.

BACKGROUND: Lack of knowledge and awareness of oral cancer seem to be the main causes of diagnostic delay. Online resources are often used by patients to obtain health/medical information. However, there are no reports on the quality and usefulness of oral cancer audio-visual resources in Spanish. The aims of this investigation were to disclose the type of information about oral cancer available, and whether it may be useful to shorten the patients' oral cancer appraisal time-interval. MATERIAL AND METHODS: Cross-sectional study undertaken at three video-sharing sites on October, 13th 2019. KEYWORDS: "Cáncer oral"; "cáncer de boca". The first 100 results in each viewing list were retrieved by three reviewers. Demographical data was recorded, and interaction indexes, viewing rates, comprehensiveness, and usefulness were calculated for each video. The presence of non-scientifically supported information was also assessed. A descriptive analysis was undertaken, and relationships between variables were explored using the Spearman correlation test. RESULTS: A total of 127 videos were selected. They were produced mainly by mass-media (46.5%; n=59) and their length ranged from 0.28 to 105.38 minutes (median 4.15 minutes; IQR: 2.34-9.67). The most viewed video (10,599,765 views; visualization rate 726,508.9) scored 0 both in usefulness and comprehensiveness. The most useful video gathered 44,119 views (visualization rate 2.033.13). A highly significant positive correlation (0.643; p<0.001) could be observed between usefulness and comprehensiveness of the videos, together with negative correlations between the visualization rate and usefulness (-0.186; p<0.05), and visualization rate and comprehensiveness (-0.183; p<0.05). CONCLUSIONS: Online audio-visual material about oral cancer in Spanish is incomplete, of limited usefulness, and often includes non-scientifically supported information. Most of these resources are produced by mass media and healthcare professionals, with minor contributions from educational and healthcare institutions. Visualization rates negatively correlated with the usefulness and comprehensiveness of the contents in these digital objects.

People would rather see a physician than a dentist when experiencing a long-standing oral ulceration. A population-based study in Spain.

BACKGROUND: Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration. MATERIAL AND METHODS: Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS: A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% of them (n=2,729) were males. Most participants (42.1%; n=2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n=1,614; 28%, n=1,600 respectively). When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n=3,597) and less than one quarter of the sample (23.8%; n=1,371) would seek consultation with their dentist. CONCLUSIONS: General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer.

Oral mucosal peeling related to dentifrices and mouthwashes: A systematic review.

BACKGROUND: The aim of this systematic review was to summarise the clinical information available about oral mucosal peeling (OMP) and to explore its aetiopathogenic association with dentifrices and mouthwashes. MATERIAL AND METHODS: PICOS outline. Population, subjects diagnosed clinically and/or pathologically. Intervention, exposition to oral hygiene products. Comparisons, patients using products at different concentrations. Outcomes, clinicopathological outcomes (primary) and oral epithelial desquamation (secondary) after use. Study design, any. Exclusion criteria, reports on secondary or unpublished data, in vitro studies. Data were independently extracted by two reviewers. RESULTS: Fifteen reports were selected from 410 identified. Descriptive studies mainly showed low bias risk, experimental studies mostly an "unclear risk". Dentifrices or mouthwashes were linked to OMP, with an unknown origin in 5 subjects. Sodium lauryl-sulphate (SLS) was behind this disorder in 21 subjects, tartar-control dentifrices in 2, and flavouring agents in 1 case. Desquamation extension was linked to SLS concentration. Most cases were painless, leaving normal mucosa after desquamation. Tartar-control dentifrices caused ulcerations more frequently. CONCLUSIONS: OMP management should consider differential diagnosis with oral desquamative lesions, particularly desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP.

Distance of the alveolar antral artery from the alveolar crest. Related factors and surgical considerations in sinus floor elevation.

BACKGROUND: In a variable proportion of maxillary sinuses alveolar antral artery is located close to the residual ridge, increasing the chances for haemorrhagic complications during sinus floor elevation procedures. MATERIAL AND METHODS: Retrospective observational study of CBCT explorations performed for implant-treatment planning. The upper first molar area was selected for this study. The relative uncertainty (standard deviation of the measurement divided by its mean and expressed as a percentage from 0% to 100%) was chosen for determining the observational errors. For modeling the chances of AAA detection, the generalized additive models (GAM) approach was chosen. RESULTS: A total of 240 maxillary sinuses were studied (46.25% males) whose median median age was 58 years old (IQR: 52-66). Univariate models showed that the chances for an AAA-alvelar crest distance ≤15mm increase in wider sinuses with lower, subsinusally edentulous crests. When distance is considered as a continuous variable, the best mutivariate model showed an explained deviance of 67% and included AAA diameter, distance AAA-sinus floor, sinus width, and shape, height and width of the residual ridge. Thinner AAAs are found closer to the crest (within the ≤15mm safe distance). CONCLUSIONS: Bearing in mind the inclusion criteria and the limitations of this investigation, it is concluded that there is a high proportion of maxillary sinuses where AAA describes a course close to the alveolar crest (≤15mm), which was classically considered a safe distance for SFE. This position is related to the presence of atrophic crests (depressed ridge form) and wide maxillary sinuses where the distance of the vessel to the floor of the sinus is small. This information may permit a better surgical planning of SFE procedures.

Influence of cardiovascular risk factors on levels of matrix metalloproteinases 2 and 9 in human abdominal aortic aneurysms.

OBJECTIVE: To evaluate the influence of cardiovascular risk factors on levels of matrix metalloproteinases (MMP) 2 and 9 in human abdominal aortic aneurysms (AAA). METHODS: Aortic samples were collected from patients who underwent AAA repair (n = 89). Patients were stratified according to the maximum transverse aorta diameter: small diameter (<55 mm), moderate diameter (55-69.9 mm) and large diameter (≥70 mm). Aortic walls were studied using real-time PCR and immunohistochemistry. MMP-2, MMP-9, α-actin, CD45, and CD68 transcript levels were determined relative to ß-actin. Quantitative data were expressed as median (IQ-range). RESULTS: No differences were found in MMP-2 expression between the patient groups, which was mainly associated with vascular smooth muscle cells (VSMC); however, MMP-9 displayed the maximum level in the moderate-diameter group, associated with infiltrating macrophages. Current smoking (CS) and renal insufficiency (RI) significantly increased local levels of MMP-2 (CS 349.5 [219.5-414.1] vs. no-CS 184.4 [100.0-320.5]; p < .008; RI 286.8 [189.6-410.8] vs. no-RI 177.3 [99.3-326.9]; p = .047). Nevertheless, after stepwise linear regression analysis only CS remained as an independent variable predicting local levels of MMP-2 (p = .002). No risk factors influenced local levels of MMP-9. CONCLUSIONS: The results show that local levels of MMP-2, an important factor for AAA development, were increased in current smoking AAA patients. MMP-2 was mainly associated with VSMC. It is suggested that MMP-2 could contribute significantly to the increased AAA growth rate observed in current smoking patients. These findings support inclusion of smokers in screening for aneurysmal disease, and emphasize the need for more aggressive monitoring of aneurysmal disease outside the surgical range in patients who smoke at the time of diagnosis and in those who continue to smoke during follow-up.

Expression of the granule-bound starch synthase I (Waxy) gene from snapdragon is developmentally and circadian clock regulated

The granule-bound starch synthase I (GBSSI or waxy) enzyme catalyzes one of the enzymatic steps of starch synthesis. This enzyme is responsible for the synthesis of amylose and is also involved in building the final structure of amylopectin. Little is known about expression of GBSSI genes in tissues other than storage organs, such as seeds, endosperm, and tuber. We have isolated a gene encoding the GBSSI from snapdragon (Antirrhinum majus). This gene is present as a single copy in the snapdragon genome. There is a precise spatial and developmental regulation of its expression in flowers. GBSSI expression was observed in all floral whorls at early developmental stages, but it was restricted to carpel before anthesis. These results give new insights into the role of starch in later reproductive events such as seed filling. In leaves the mRNA level of GBSSI is regulated by an endogenous circadian clock, indicating that the transition from day to night may be accompanied by abolition of expression of starch synthesis genes. This mechanism does not operate in sink tissues such as roots when grown in the dark.

Hábitos de higiene oral. Resultados de un estudio poblacional / Oral hygiene habits. Results of a population-based study

Las patologías orales, además de muy prevalentes, tienen un impacto sistémico que puede prevenirse eliminando regularmente el biofilm dental. Este estudio transversal de base poblacional analizó los hábitos de higiene oral referidos por 3.289 adultos mediante encuestas comunitarias en las cuatro capitales de Galicia entre marzo de 2015 y junio de 2016. Se registró sexo, nivel de alerta periodontal, nivel de estudios, hábito tabáquico, régimen de visitas odontológicas y nivel de higiene oral según el uso de elementos de higiene oral y su frecuencia de uso. La higiene oral se limitó al cepillado dental al menos una vez al día en el 86% de los encuestados, siendo minoritaria la higiene interdental regular. Las variables asociadas a buenos hábitos fueron la alerta periodontal, las visitas odontológicas frecuentes, ser mujer, y alto nivel educativo. Los autocuidados orales son inadecuados, especialmente en higiene interdental, lo que justifica la necesidad de intervenciones educativas de ámbito comunitario

Oral pathologies, in addition to being highly prevalent, have a systemic impact that can be prevented by regularly eliminating the dental biofilm. This population-based, cross-sectional study analysed the oral hygiene habits of 3,289 adults through community surveys in the four provincial capitals of Galicia between March 2015 and June 2016. Sex, level of periodontal awareness, education, tobacco habit, frequency of visits to the dentist and level of oral hygiene were registered according to the use of oral hygiene products and the frequency of their use. Oral hygiene was limited to brushing their teeth once a day in 86% of those surveyed, while regular interdental hygiene was a minority practice. The variables associated with good habits were periodontal awareness, frequent visits to the dentist, being a woman and a high educational level. Oral self-care is insufficient, especially in interdental hygiene, which justifies the need for educational interventions in the community

Application of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to the structure determination of medium and large macrocycles formed by palladium(0)-catalyzed allylation of arenesulfonamides, sulfamide, and cyanamide.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry allowed the direct determination of the extent of macrocyclic and linear oligomer formation in the palladium(0)-catalyzed allylation of highly acidic and non-nucleophilic arenesulfonamides, sulfamide, and cyanamide. Palladium-containing 15-membered-ring macrocyclic compounds gave unusual [M - H](+) ions besides [M + Na](+) and [M + K](+) adducts. Copyright 1999 John Wiley & Sons, Ltd.

Derrame pleural masivo como forma de presentación de un tumor de Krukenberg. Linfangitis carcinomatosa secundaria / Massive pleural effusion as a form of presentation of a Krukenberg tumor. Secondary carcinomatous lymphangitis

Presentamos el caso clínico de una paciente joven que acudió a Urgencias por disnea, objetivándose en la radiografía de tórax un derrame pleural derecho masivo y en la ecografía transvaginal, efectuada tras el hallazgo de un test de embarazo positivo, una masa ovárica. En la TC toraco-abdominal se observó, además, un engrosamiento de la mucosa gástrica, que fue valorado mediante gastroscopia, siendo la biopsia positiva para adenocarcinoma de células en anillo de sello. Ante estos hallazgos se confirmó el diagnóstico de tumor de Krukenberg, entidad poco frecuente con una forma de presentación también excepcional en forma de falso síndrome de Meigs. Una vez iniciado el tratamiento sistémico la paciente presentó, como una complicación de su enfermedad de base, hallazgos compatibles con una linfangitis carcinomatosa, que condicionó la necesidad de oxigenoterapia domiciliaria

We present the clinical case of a young patient who came to the emergency department due to dyspnea, showing a massive right pleural effusion on the chest radiograph and an ovarian mass on the transvaginal ultrasound, performed after the finding of a positive pregnancy test. In the thoraco-abdominal CT scan, a thickening of the gastric mucosa was also observed, which was valued by gastroscopy, with a positive biopsy for adenocarcinoma of cells in the signet ring. Given these findings, the diagnosis of Krukenberg tumor was confirned, a rare entity with an exceptional form of presentation in the form of false Meigs syndrome. Once the systemic treatment was begun the patient presented, as a complication of the underlying disease, findings compatible with a carcinomatous lymphangitis, which conditioned the need for home oxygen therapy

Tratamiento anticoagulante extendido de la enfermedad tromboembólica venosa con anticoagulantes orales directos / Extended anticoagulant treatment of venous thromboembolic disease with direct oral anticoagulants

Los anticoagulantes orales directos han demostrado eficacia y seguridad en el tratamiento de la enfermedad tromboembólica venosa. En este artículo se revisan los resultados de los anticoagulantes orales directos en los ensayos clínicos publicados en el tratamiento anticoagulante extendido (tras los 3-6 primeros meses iniciales de tratamiento) de la enfermedad tromboembólica venosa

Direct oral anticoagulants have demonstrated efficacy and safety in the treatment of venous thromboembolic disease. A review is presented of the results of direct oral anticoagulants in the published clinical trials of extended anticoagulant treatment (after the first 3-6 months of treatment) of venous thromboembolic disease

La elección de la especialidad medicina intensiva: análisis de los últimos 10 años / Choice of critical care medicine: Analysis of the last 10 years

No disponible

SCORE-IT: the Spot Sign score in restricting ICH growth─an Atach-II ancillary study.

INTRODUCTION: The ATACH-II trial is designed to evaluate whether intensive blood pressure reduction can reduce hematoma growth and improve outcome. However, it is difficult to determine, at presentation, which patients are at highest risk of ongoing bleeding, and will receive the most clinical benefit from blood pressure therapy. It may be that improved predictive markers will lead to efficient, personalized selection of optimal therapy. We hypothesize that specific imaging findings on CT angiography (CTA) and MRI will mark those patients who receive the most benefit from intensive blood pressure reduction. METHODS: Many patients enrolled in ATACH-II will undergo CTA and/or MRI as part of routine clinical care. We will perform a blinded analysis of these images. For CTA, we will determine the presence of contrast pooling (also termed contrast extravasation or the "Spot Sign"). In addition, we will calculate a Spot Sign Score, a score that includes number of Spot Signs, diameter, and contrast density. For MRI, we will focus on the presence, number, and location of cerebral microbleeds (CMBs) on sensitive T2*-weighted MRI sequences. RESULTS: We will test the hypothesis that patients with a Spot Sign will receive clinical benefit from intensive blood pressure reduction. In addition, we will determine whether patients with the highest Spot Sign Scores receive the most benefit from intensive blood pressure reduction. Finally, we will determine whether the absence of CMBs marks those at higher risk for hematoma expansion, and therefore more likely to benefit from treatment. CONCLUSION: This ancillary study offers the tremendous opportunity to determine whether imaging findings can risk stratify ICH patients for acute therapies aimed at limiting hematoma growth.

Actualización en medicina de familia: patología periodontal / Update in family medicine: periodontal disease

En España entre el 85-94% de la población mayor de 35 años sufre algún problema de las encías, y entre el 15-30% padece periodontitis, siendo las formas severas un 5-11% de los casos. A diferencia de otras entidades inflamatorias, la enfermedad periodontal rara vez causa molestias, limita la vida o causa alteraciones funcionales hasta que la enfermedad progresa y aparecen signos clínicos (recesión gingival, migración patológica de los dientes, movilidad) en estadios avanzados de la enfermedad. El desconocimiento de la enfermedad, ligado con la falsa creencia de que la pérdida dentaria es una causa inexorable de la edad, repercute en un diagnóstico tardío, requiriendo enfoques del tratamiento más complejos y con un peor pronóstico. En el ámbito de la medicina de atención primaria hay una serie de fármacos asociados con la enfermedad periodontal, con la presencia de agrandamiento gingival (anticonvulsivantes, inmunosupresores y bloqueadores de los canales del calcio) como efectos secundarios, con variabilidad en cuanto a su presencia y severidad en función de la cantidad de placa acumulada. El estrés y la depresión son estados que alteran la respuesta del sistema inmune y aumentan la respuesta inflamatoria, incrementando la susceptibilidad de la periodontitis. Asimismo, se han asociado una serie de enfermedades sistémicas a la periodontitis, entre las que se encuentran la diabetes mellitus, la enfermedad cardiovascular, las enfermedades respiratorias y las complicaciones de la gestación (AU)

About 85-94% of the Spanish adults older than 35 experience gum problems, and about 15-30% suffer from periodontitis, being severe in up to 5-11% of them. Unlike other inflammatory conditions, periodontal disease rarely causes discomfort, or limits life or causes functional limitations until its advanced stages, when clinical signs and symptoms arise (gingival recession, pathological teeth migration, or mobility). Lack of knowledge about the disease, together with the idea that tooth loss is linked to ageing, frequently results in a late diagnosis, requiring extensive treatments with a worse prognosis. At Primary Care level, there is series of drugs have been related to periodontal disease (anticonvulsants, immunosuppressive drugs, and calcium channel blockers) as secondary effects, which vary as regards their frequency and severity depending of the amount of accumulated plaque. Stress and depression have also been reported to alter the immune response and to increase the inflammatory response as well as periodontal susceptibility. Certain systemic conditions, such as diabetes mellitus, cardiovascular disorders, respiratory diseases, as well as low-weight pre-term birth, have also been linked to periodontitis (AU)

Soporte mecánico con membrana de oxigenación extracorpórea veno-arterial (ECMO-VA): evolución a corto y a largo plazo tras la retirada de la asistencia / Mechanical support with venoarterial extracorporeal membrane oxygenation (ECMO-VA): Short-term and long-term prognosis after a successful weaning

Objetivo: La membrana de oxigenación extracorpórea (ECMO) es un tipo de asistencia circulatoria que asocia elevada mortalidad. Sin embargo, superar la fase inicial de soporte mecánico no implica supervivencia ni a corto ni a largo plazo. Objetivo: describir las características y evolución de los pacientes con shock cardiogénico refractario (SCR) asistidos con ECMO veno-arterial (ECMO-VA) en un hospital con programa de trasplante cardíaco. Diseño: Estudio de cohortes y retrospectivo de centro único. Ámbito: UCI cardiológica de un hospital terciario. Pacientes: Un total de 46 pacientes asistidos consecutivamente con una ECMO-VA durante 6 años. Intervenciones: Análisis de la mortalidad hospitalaria tras la retirada del soporte mecánico, de la supervivencia global (SG) y de los factores asociados. Resultados: Quince pacientes (33%) fallecieron con la ECMO-VA y 31 (67%) sobrevivieron a su retirada tras un soporte de 8 días (RIC: 5-15); 14 pacientes fueron trasplantados. La mortalidad hospitalaria en estos pacientes fue del 32% (10/31) y se relacionó con: edad (p=0,001), SAPS-II (p=0,009), sangrado de cánulas (p=0,01), indicación de SCR post-IAM (p=0,001). Con una mediana de seguimiento de 27 meses (RIC: 11-49), seguían vivos el 91% de los pacientes que fueron dados de alta del hospital. La SG tras la retirada de la ECMO-VA se relacionó con el tipo de indicación (p=0,002), teniendo peor pronóstico los pacientes con SCR postinfarto. Conclusiones: En nuestra experiencia, la ECMO-VA es un tipo de asistencia mecánica que puede utilizarse en el manejo del SCR. Asocia una mortalidad precoz elevada, pero tras superar la fase hospitalaria la supervivencia de los pacientes es buena (AU)

Objective: Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. Design: A single-center, retrospective cohort study was carried out. Setting: The cardiovascular ICU of a tertiary hospital. Patients: Forty-six patients consecutively subjected to VA-ECMO over 6 years. Interventions: Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed. Results: Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. Conclusions: In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good (AU)

Ictus isquémico secundario a arteriopatía focal cerebral unilateral / Ischaemic stroke secondary to unilateral focal cerebral arteriopathy

No disponible

Trastornos del sueño no respiratorios en relación con ictus / Non-breathing-related sleep disorders following stroke

Introducción: Actualmente se reconoce que los trastornos respiratorios, en especial la apnea del sueño, son frecuentes en pacientes con accidente vascular cerebral y que su presencia reduce el potencial de recuperación neurológica de estos pacientes. Sin embargo, es poco conocido el hecho de que otros trastornos del sueño que también se producen a consecuencia de un ictus como la somnolencia diurna, el insomnio y los trastornos del movimiento también son capaces de producir o incrementar la discapacidad asociada al ictus. Desarrollo: Estudios polisomnográficos han evidenciado múltiples alteraciones en la arquitectura del sueño de los pacientes en la fase aguda del ictus, las cuales tienden a mejorar con el transcurso del tiempo pero manteniendo un efecto deletéreo sobre la calidad de vida. Lo mismo ocurre con trastornos del sueño que se producen como consecuencia de un ictus (el insomnio, la narcolepsia, el síndrome de piernas inquietas, los movimientos periódicos de las piernas y el trastorno de conducta del sueño MOR) todos los cuales son potencialmente tratables. Con el objetivo de incrementar la conciencia acerca de estas condiciones y sus efectos sobre los pacientes con ictus, se revisa brevemente la epidemiología y fisiopatología en la subpoblación de pacientes neurológicos con ictus. Conclusiones: A diferencia de los trastornos respiratorios, otros trastornos del sueño han sido escasamente estudiados en pacientes con ictus, a pesar de que prácticamente todos los trastornos del sueño pueden presentarse a consecuencia de esta enfermedad

Introduction: It has been shown that sleep-related breathing disorders, especially sleep apnea, are very common in patients who have had a stroke, and that they also reduce the potential for neurological recovery. Nevertheless, other sleep disorders caused by stroke (excessive daytime sleepiness, insomnia, sleep related movement disorders) can also cause or increase stroke-related disability, and this fact is less commonly known. Development: Studies with polysomnography have shown many abnormalities in sleep architecture during the acute phase of stroke; these abnormalities have a negative impact on the patient's quality of life although they tend to improve with time. This also happens with other sleep disorders occurring as the result of a stroke (insomnia, narcolepsy, restless legs syndrome, periodic limb movement disorder and REM sleep behavior disorder), which are nevertheless potentially treatable. In this article, we briefly review the physiopathology and epidemiology of the disorders listed above in order to raise awareness about the importance of these disorders and the effects they elicit in stroke patients. Conclusions: Sleep disorders that are not breathing-related have scarcely been studied in stroke patients despite the fact that almost all such disorders may present as a result of a cerebrovascular event

Heparinas de bajo peso molecular en pacientes con fibrilación auricular / Low-molecular-weight heparins in patients with atrial fibrillation

En la práctica clínica, las heparinas de bajo peso molecular se utilizan con relativa frecuencia en pacientes con fibrilación auricular con el objetivo de prevenir eventos embólicos. En este artículo se revisa la evidencia disponible en las siguientes situaciones clínicas: inicio rápido de anticoagulación, tratamiento «puente» (en sustitución del tratamiento anticoagulante oral crónico en relación con un procedimiento invasivo) y cardioversión guiada por ecocardiograma transesofágico (AU)

In clinical practice, low-molecular-weight heparins are used relatively frequently in patients with atrial fibrillation to prevent embolic events. In this article, it is revised the available evidence in the following clinical situations: rapid onset of anticoagulation, bridging therapy (replacing long-term oral anticoagulant therapy around an invasive procedure) and transesophageal echocardiography-guided cardioversion (AU)

Psicopatía, violencia y criminalidad: un análisis psicológico-forense, psiquiátrico-legal y criminológico (Parte I) / Psychopathy, violence and crime: a psychological-forensic, psychiatric-legal and criminological analysis (Part I)

Tras más de 200 años de historia, el concepto de “psicopatía” ha venido experimentando una auténtica y variopinta metamorfosis terminológica. Exceptuando aquellos períodos del Medievo en los que se creía que la psicopatía y cualquier otra conducta y personalidad “anormales” eran bien de origen demoníaco, bien de corte estrictamente hereditarista- biologicista-fisionomista-antropométrico, el resto de enfoques teórico-investigadores han arrojado sobrada luz que, a día de hoy, y tras más de 200 años de historia amarga y controvertida sobre el término, nos permiten haber llegado a un consenso generalizado entre los estudiosos de la psicopatía desde el punto de vista clínico-forense y criminológico. Este primer trabajo o Parte I es una revisión en la que se pretende ahondar en los polémicos y muchas veces incomprobables orígenes del término “psicopatía”. Por otro lado, y tras intensas investigaciones empíricas realizadas desde los años 70 y centradas fundamentalmente en la población penitenciaria, modernamente se ha comenzado a hablar, de manera distintiva, tanto de los psicópatas criminales como de los psicópatas integrados, habiéndose hallado que la diferencia principal entre ambos tipos de psicópatas estriba, sencillamente, en la concreta comisión de delitos, puesto que la estructura básica de personalidad es prácticamente la misma en ambos tipos de psicópatas. Finalmente, se hace muy necesario subrayar que el carácter antisocial de la personalidad y conducta se observa, por definición, en cualquier tipo de delincuentes, sean éstos o no psicópatas, un carácter antisocial que, por otro lado, no siempre ni necesariamente se observa entre los denominados psicópatas integrados (AU)

After more than 200 years of history, the concept of “psychopathy” has been undergoing an authentic and varied terminological metamorphosis. Except for those periods in the Medieval Age in which it was believed that psychopathy and other “abnormal” behaviors and personalities were either from a demonic origin, or from a strictly hereditarianbilogicist- physiognomic-anthropometric origin, the other theoretical-research approaches have cast on light that, on today, and after over 200 years of bitter and controversial history of the term, allow us to have reached a broad consensus among scholars of psychopathy from a clinical-forensic and criminological standpoint. This first paper or Part I is a review that aims to delve into the controversial and often unverifiable origins of the term “psychopath”. On the other hand, after intense empirical research since the 70's and focused primarily on the prison population, modernity it has begun to talk differently about both criminal psychopaths as successful psychopaths, having found that the main difference between the two types of psychopaths lies simply in the concrete crimes, being as the basic structure of personality is almost the same in both types of psychopaths. Finally, it’s very necessary to emphasize that the antisocial character of the personality and behavior is observed, by definition, in any criminal, whether or not psychopaths, an antisocial character, on the other hand, which does not always or necessarily seen between the so-called successful psychopaths (AU)

Psicopatía, violencia y criminalidad: un análisis psicológico-forense, psiquiátrico-legal y criminológico (Parte II) / Psychopathy, violence and crime: a psychological-forensic, psychiatric-legal and criminological analysis (Part II)

La Jurisprudencia española se encuentra frecuentemente ante dictámenes periciales en los que aparecen términos como psicópata, trastorno antisocial de la personalidad, personalidad psicopática, psicópata desalmado, psicopatía epileptoide, sociopatía, etc. De esta forma, no es infrecuente que los juristas (magistrados, jueces, fiscales, abogados) se hallen desorientados ante tanta terminología que, pese a todo, en absoluto se constituyen en sinónimos. La Doctrina, por su parte, disiente de la visión tradicionalmente ya asentada en la Jurisprudencia de que los psicópatas sean sujetos inimputables. Muchos penalistas conocen bien los textos y estudios psicológicos y psiquiátricos que al respecto existen, y en ellos suelen basarse para establecer ciertas diferencias que aparentemente son sutiles. Una de las controversias más prolongadas es si los términos trastorno antisocial de la personalidad y psicopatía son la misma entidad. En la revisión de esta Parte II también se pretende ahondar en y remarcar esas sutiles diferencias, ya que se ha demostrado reiteradamente que ambas entidades diagnósticas, si bien comparten algunos rasgos en común, no son el mismo concepto ni comportan las mismas consecuencias. Asimismo, se analiza la enconada polémica que existe en torno a la frecuente asociación entre psicopatía y consumo de drogas, una polémica que parece sentar sus orígenes en esa misma confusión terminológica entre psicopatía y trastorno antisocial de la personalidad. Finalmente, se revisa la bibliografía relativa a la criminalidad de los psicópatas, haciendo especial referencia tanto al caso de los delincuentes comunes como al caso de los asesinos en serie y otros delincuentes violentos, sin perder de vista la posición que actualmente tienen los psicópatas a nivel penológico, doctrinal y jurisprudencial (AU)

Spanish jurisprudence is frequently faced with the fact that in some expert reports appear terms like psychopath, antisocial Personality disorder, psychopathic personality, cruel psychopath, epileptoid psychopathy, sociopathy, etcetera. In this way, it's not infrequent that jurists (magistrates, judges, public prosecutors, lawyers) became disorientated with so much terminology which, despite all, they are nothing at all about synonym terms. Doctrine, on the other hand, dissents from the traditionally point maintained by the Jurisprudence that psychopaths are non-attributed individuals. Many penologists know very good psychological and psychiatric manuals and research studies on subject, and they are usually based on them to make some differences which apparently are fines. One of the controversies more extended is if the terms antisocial personality disorder and psychopathy are the same category. In the review of this Part II, it's also pretended to go deeply into and emphasize those fine differences, now that it's been proved repeatedly that both diagnosis categories, if it's of course true that they share some common features, they are neither the same concept nor involve the same consequences. It also examines the bitter controversy that exists regarding the frequent association between psychopathy and substance abuse, a controversy that seems to set its roots in the same terminological confusion between psychopathy and antisocial personality disorder. Finally, we review the literature about the criminality of psychopaths, with special reference to the case of both common criminals and the case of serial murderers and other violent criminals, without losing sight of the position that psychopaths currently have at a penological, doctrinal and jurisprudential level (AU)