Parir en palacio: Obstetricia de las reinas españolas / Giving birth in the palace: Obstetrics of Spanish queens

El parto siempre ha sido un hecho muy importante en la vida de la mujer por el riesgo y repercusión social que entraña, pero si la parturienta es una reina, la trascendencia es enorme. Las soberanas, pese al riesgo que corrían tanto ellas como el vástago, tenían que parir hijos y cuantos más mejor. En este trance siempre han contado con la ayuda de matronas y comadres, aplicando para ello los conocimientos obstétricos clásicos [Fragmento de texto] (AU)

Evaluación preoperatoria «on line» frente a evaluación presencial: optimización de recursos / Online versus non-standard face to face preoperative assessment: Cost effectiveness

Objetivos. Evaluar la implementación de un nuevo modelo de consulta preoperatoria mediante la reducción de visitas presenciales y pruebas complementarias en distintos procedimientos. Métodos. Desarrollamos un nuevo modelo de evaluación preoperatoria en el que el anestesiólogo evalúa on line, sin presencia del paciente, la historia clínica y las pruebas complementarias procedentes de la atención primaria y hospitalaria. A partir de esa información, confirmada mediante una llamada telefónica, el especialista decidía la necesidad de visita presencial y seleccionaba las pruebas complementarias en base a la complejidad del procedimiento quirúrgico y riesgo anestésico del paciente. En determinados procedimientos la enfermera previamente «entrenada» recogía on line dicha información y en caso de duda consultaba al anestesiólogo. Comparamos una cohorte de pacientes prequirúrgicos antes de la implantación de este nuevo modelo preoperatorio (año 2008) y después (año 2010). Contabilizamos en ambos períodos, el número de visitas presenciales y pruebas complementarias realizadas. Se comparó la tasa de anulaciones quirúrgicas para ambos períodos. Resultados. Se valoraron 5.112 procedimientos de cirugía programada en el año 2008 y 6.867 procedimientos en el 2010. La complejidad quirúrgica fue similar en ambos períodos. En el 2010 las visitas presenciales descendieron a un 21%, el número de analíticas a un 15%, el de electrocardiogramas a un 6% y el número de radiografías de tórax a un 1%. La tasa de anulaciones quirúrgicas descendió del 2,3 al 1,75%. Conclusiones. Este método preoperatorio optimiza los recursos al reducir las visitas presenciales y las pruebas complementarias sin aumentar la tasa de anulaciones quirúrgicas(AU)

Objectives. We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests. Methods. We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods. Results. 5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn’t differ between 2008 (2,3%) and 2010 (1.75%). Conclusions. This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate(AU)

[Online versus non-standard face to face preoperative assessment: cost effectiveness]. / Evaluación preoperatoria «on line¼ frente a evaluación presencial: optimización de recursos.

OBJECTIVES: We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests. METHODS: We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods. RESULTS: 5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn't differ between 2008 (2,3%) and 2010 (1.75%). CONCLUSIONS: This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate.

Síndrome de hipersensibilidad a anticonvulsivos inducido por carbamazepina / Hypersensibility reaction to anticonvulsants induced by carbamazepine

Los anticomiciales aromáticos, en especial, la fenitoína, pueden causar una reacción de hipersensibilidad típicamente caracterizada por sintomatología cutánea y sistémica variable (hepatopatía, adenopatías, mielotoxicidad, etc.), cuyo desenlace puede ser fatal en función de la precocidad diagnóstica, tiempo de uso del fármaco e intensidad de la afectación sistémica. Su incidencia oscila entre 1/1.000 y 1/10.000 exposiciones a esta sustancia y, habitualmente, comienza entre 1 y 3 meses después del inicio del agente causal. No se conoce a ciencia cierta su mecanismo de producción, aunque parecen implicados complejos procesos inmunopatogénicos. La supresión del medicamento y el tratamiento esteroide y antihistamínico suelen ser medi-das suficientes para la normalización clínico-analítica en un plazo de 4 a 10 semanas (AU)

Glycaemic control and in vivo non-oxidative Maillard reaction: urinary excretion of pyrraline in diabetes patients.

The presence of pyrraline in human urine has recently been described. Using reversed-phase high-performance liquid chromatography, we measured urinary pyrraline in 45 insulin-treated diabetic patients with preserved renal function and in 30 age- and sex-matched healthy subjects. The relationship between urinary pyrraline and metabolic control parameters in the diabetic population (glycaemia, fructosamine, haemoglobin A1c, and 1-year mean haemoglobin A1c) was evaluated. The mean urinary level of pyrraline in diabetic patients with poor glycaemic control (HbA1c > 9.5%) was higher than that in healthy subjects (1.12 +/- 0.35 vs. 0.75 +/- 0.2 mumol mmol-1 creatinine, P < 0.04), whereas in patients with good to moderate glycaemic control (HbA1c < 9.5) it was slightly but not significantly higher than in healthy subjects (0.80 +/- 0.3 mumol mmol-1 creatinine vs. 0.75 +/- 0.2 mumol mmol-1 creatinine). There is a significant correlation between urinary pyrraline level and glycaemia (P < 0.008), haemoglobin A1c (P < 0.01) and 1-year mean haemoglobin A1c values (P < 0.007), but not with fructosamine. The results of the present work prove, for the first time, that glycaemic status influences circulating levels of advanced Maillard reaction products.

Urinary pyrraline as a biochemical marker of non-oxidative Maillard reactions in vivo.

The presence of pyrraline, a non-oxidative glucose-derived Maillard reaction product in plasma proteins has been established previously. In this study we have investigated the presence of pyrraline in human urine to determine whether pyrraline-containing proteins are metabolized or selectively retained. Pyrraline was detected by means of HPLC, and its presence was confirmed by UV and electrospray-mass spectrometry. The quantification of pyrraline in urine from healthy individuals showed 1.21 +/- 0.4 micrograms/mg creatinine. In urine from diabetic patients, pyrraline levels varied considerably, although the mean level was higher than in healthy subjects (1.37 +/- 0.6 micrograms/mg creatinine). These data further support the presence of a catabolic pathway for advanced non-oxidative Maillard reaction products in vivo and suggest their role in the pathogenesis of diabetes.

[Presence of markers predictive of type I pre-diabetes mellitus status in relatives of patients with type I diabetes mellitus]. / Presencia de marcadores predictivos del estado de prediabetes mellitus tipo I en familiares de pacientes con diabetes mellitus tipo I.

BACKGROUND: The aim of this study was to analyze the predictive factors of IDDM in first degree relatives of IDDM patients. SUBJECTS AND METHODS: From 1992 to 1994, 1,053 first degree relatives were screened for measuring islet cell antibodies (ICA) by indirect immunofluorescence (iFl). In all ICA positive subjects, beta cell function was analyzed by intravenous glucose tolerance test (IVGTT) and other immunologic parameters were also studied: anti-insulin antibodies (IAA) by radiobinding and antibodies to glutamic acid decarboxylase (GADAb) by ELISA methods. RESULTS: ICA were found in 3.1% of the first degree relatives. IVGTT showed a significant decrease in acute first phase of insulin response to glucose (IRI 1 minute + 3 minute) in those with ICA > or = 20 JDF units. In patients with ICA > or = 20 JDF units, 20% were found to be positive for IAA and 40% were positive for GAdAb. Thirty-one percent (10/32) of ICA positive first degree relatives fulfilled prediabetes criteria. During follow-up, 40% (4/10) of these prediabetic patients developed IDDM. CONCLUSION: This study confirms the possibility of identifying among first degree relatives of IDDM patients the subgroup with high risk of developing IDDM thus allowing the initiation of therapy for preventing or delaying IDDM onset.

Prevalence of islet cell antibodies, insulin antibodies and hyperglycaemia in 2291 schoolchildren.

Islet cell antibodies, insulin antibodies and hyperglycaemia were investigated in 2291 healthy schoolchildren. Eight of the subjects had islet cell antibodies and eight had insulin antibodies. However, no schoolchild who was positive for islet cell antibodies also had insulin antibodies present. Hyperglycaemia was observed in five children but neither islet cell antibodies nor insulin antibodies could be detected in the sera from these particular subjects.

Somatostatin and counterregulatory hormone responses to hypoglycaemia in diabetics with and without autonomic neuropathy.

Blood glucose, somatostatin and counterregulatory hormone responses to an i.v. bolus of insulin were studied in insulin-dependent diabetics with different degrees of autonomic neuropathy, after 24 hours of optimised control with an artificial pancreas. There was no plasma catecholamine response in patients with a sympathetic autonomic neuropathy. A normal somatostatin response to hypoglycemia was absent in patients with autonomic neuropathy. Glucagon did not respond in diabetics, independently of the degree of neuropathy. In all diabetics, cortisol and GH were stimulated. Absence of warning symptoms was observed in patients with catecholamine deficiency. Despite different hormone behaviour, blood glucose fall and recovery were similar in all diabetic groups. It is concluded that the glucagon response to insulin hypoglycaemia is reduced in all type 1 longstanding diabetics, whereas catecholamine and somatostatin responses are only abolished in those with autonomic neuropathy. Patients with sympathetic neuropathy would be considered at increased risk severe hypoglycaemia.