Manejo de las rinosinusitis en Atención Primaria / Management of Rhinosinusitis in Primary Care

La rinosinusitis aguda representa un importante problema de salud, y, aunque su frecuencia no está bien establecida en nuestro país, es motivo de una no desdeñable carga económica, alterando notablemente la calidad de vida de los pacientes que la padecen. Su diagnóstico es eminentemente clínico, debiendo reservar las exploraciones complementarias para el diagnóstico diferencial de las complicaciones y de procesos tumorales. Las causas más frecuentes son las infecciones, siendo los virus los agentes más comunmnte implicados. De entre las bacterias Streptococcus pneumoniae y Haemophilus influenzae son las más habitualmenta aisladas. Hoy las complicaciones no son frecuentes, pero sí pueden llegar a ser graves, de las cuales las más comunes son las orbitarias, seguidas de las endocráneales y las óseas. El tratamiento se basa en médidas sintomáticas, como los lavados con soluciones salinas y antibióticos para los casos de etiología bacteriana. Management of Rhinosinusitis in Primary Care

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin

[Management of Rhinosinusitis in Primary Care]. / Manejo de las rinosinusitis en Atención Primaria.

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin.

Incumplimiento del tratamiento antibiótico sistémico prescrito en servicios de urgencias de Atención Primaria (Estudio INCUMAT) / Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT’)

Introducción. El incumplimiento del tratamiento antibiótico tiene graves consecuencias. Por otro lado, los antibióticos son fármacos muy prescritos y existen pocos estudios que evalúen el cumplimiento terapéutico en enfermedades agudas. El objetivo principal de este estudio consiste en establecer el porcentaje de incumplimiento del tratamiento antibiótico sistémico prescrito en Urgencias de Atención Primaria. Material y métodos. Estudio observacional prospectivo, realizado en Urgencias de 2 centros de salud del Servicio Cántabro de Salud entre junio y septiembre de 2014. Evaluó a 303 pacientes a los que se les prescribe un antibiótico sistémico por cualquier enfermedad infecciosa, de cualquier edad y a los que se les puede hacer un seguimiento. Se estudiaron variables sociodemográficas, dolencias y cumplimiento (test de Morisky-Green y 3 preguntas añadidas por los autores). Resultados. El incumplimiento, valorado por el test de Morisky-Green, fue del 32,7% (IC 95% 27,6-38,1), aumentando esta prevalencia al 44,9% (IC 95% 39,4-50,5) al asociar al test de Morisky-Green 3 preguntas añadidas por los autores. Se aprecia una tendencia descendente en el incumplimiento conforme mayor es la edad. El riesgo de ser incumplidor es el doble en varones que en mujeres: OR=2,02 (IC 95% 1,27-3,24). Conclusiones. El 45% de los pacientes a los que se les prescribe un antibiótico no cumplen con las indicaciones. El olvido es la causa que dan en su mayoría para no cumplir correctamente el tratamiento prescrito. Los ancianos y las mujeres cumplen mejor, lo que debería tenerse en cuenta a la hora de diseñar estrategias de mejora en el cumplimiento terapéutico (AU)

Introduction. Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. Material and methods. A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. Results. Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). Conclusions. Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance (AU)

[Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT')]. / Incumplimiento del tratamiento antibiótico sistémico prescrito en servicios de urgencias de Atención Primaria (Estudio INCUMAT).

INTRODUCTION: Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. MATERIAL AND METHODS: A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. RESULTS: Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). CONCLUSIONS: Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance.

Influence of different anoxic time exposures on active biomass, protozoa and filamentous bacteria in activated sludge.

Medium-sized wastewater treatment plants are considered too small to implement anaerobic digestion technologies and too large for extensive treatments. A promising option as a sewage sludge reduction method is the inclusion of anoxic time exposures. In the present study, three different anoxic time exposures of 12, 6 and 4 hours have been studied to reduce sewage sludge production. The best anoxic time exposure was observed under anoxic/oxic cycles of 6 hours, which reduced 29.63% of the biomass production compared with the oxic control conditions. The sludge under different anoxic time exposures, even with a lower active biomass concentration than the oxic control conditions, showed a much higher metabolic activity than the oxic control conditions. Microbiological results suggested that both protozoa density and abundance of filamentous bacteria decrease under anoxic time exposures compared to oxic control conditions. The anoxic time exposures 6/6 showed the highest reduction in both protozoa density, 37.5%, and abundance of filamentous bacteria, 41.1%, in comparison to the oxic control conditions. The groups of crawling ciliates, carnivorous ciliates and filamentous bacteria were highly influenced by the anoxic time exposures. Protozoa density and abundance of filamentous bacteria have been shown as promising bioindicators of biomass production reduction.

PanGen-Fam: Spanish registry of hereditary pancreatic cancer.

PURPOSE: To describe the organisation of the registry and the preliminary results in terms of characteristics of high-risk pancreatic ductal adenocarcinoma (PDAC) families recruited to date and findings of the screening programme. To compare early onset sporadic cases (⩽50 years), sporadic cases (>50 years) and cases with family history of cancer, for PDAC possible risk factors. METHODS/PATIENTS: Families with hereditary cancer syndromes predisposing to PDAC were recruited from two main sources: Spanish hospitals participating in PanGenEU, a pan-European multicentre case-control study, and their genetic counseling unit. Individuals at high-risk of PDAC were enrolled into a screening programme, consisting of Endoscopic ultrasound, computerised tomography, magnetic resonance imaging. Genetic testing of candidate genes was offered according to each patient's risk. RESULTS: Among 577 consecutive PDAC cases, recruited via PanGenEU, 36 (6%) had ⩾2 first-degree relative with PDAC: Familial pancreatic cancer (FPC). So far PanGen-Fam has recruited 42 high-risk PDAC families; 25 (60%) had FPC. Five index cases with cancer were positive for BRCA2 and one for BRCA1 germline mutations. In the second year of prospective PDAC screening, one neuroendocrine tumour and a high-grade dysplasia lesion suspicious of carcinoma were diagnosed among 41 high-risk individuals. Furthermore EUS detected chronic-pancreatitis-like parenchymal changes in 15 patients. CONCLUDING STATEMENT: The identification and recruitment of PDAC high-risk families into the PanGen-Fam registry provides an opportunity to detect early onset cancer and precursor pancreatic cancer lesions at a potentially curative stage and to increase the knowledge of the natural history of the disease.

Interaction of silver atomic quantum clusters with living organisms: bactericidal effect of Ag3 clusters mediated by disruption of topoisomerase-DNA complexes.

Essential processes for living cells such as transcription and replication depend on the formation of specific protein-DNA recognition complexes. Proper formation of such complexes requires suitable fitting between the protein surface and the DNA surface. By adopting doxorubicin (DOX) as a model probe, we report here that Ag3 atomic quantum clusters (Ag-AQCs) inhibit the intercalation of DOX into DNA and have considerable influence on the interaction of DNA-binding proteins such as topoisomerase IV, Escherichia coli DNA gyrase and the restriction enzyme HindIII. Ag-AQCs at nanomolar concentrations inhibit enzyme activity. The inhibitory effect of Ag-AQCs is dose-dependent and occurs by intercalation into DNA. All these effects, not observed in the presence of Ag+ ions, can explain the powerful bactericidal activity of Ag-AQCs, extending the knowledge of silver bactericidal properties. Lastly, we highlight the interest of the interaction of Ag clusters with living organisms, an area that should be further explored due to the potential consequences that it might have, both beneficial and harmful.

[Mechanical ventilation induced lung injury]. / Lesión pulmonar inducida por la ventilación mecánica.

Mechanical ventilation is associated with important complications, among which production or perpetuation of acute lung injury and product of distant organ injuries of the lung basically through the release of inflammatory mediators to the systemic circulation. There is increasingly greater evidence in both in vitro and in vivo experimental models that show the reality of this lesional mechanism. The main lesional mechanisms are both stretching and rupture of the lung structures (volutrauma) and cyclical opening and closure of the closed alveolar zones (atelectrauma). Studies on the use of protective lung ventilation strategies have shown a beneficial effect in patients with ARDS of the use of open lung ventilation strategies, use of circulating volumes less than 10 ml/kg and of maintaining alveolar pressure under 30 cm of H2O. It should be investigated if these same strategies would be useful in preventing the appearance of ARDS in mechanically ventilated patients for another reason, basically in those with risk factors for the development of this condition.

Lesión pulmonar inducida por la ventilación mecánica / Mechanical ventilation induced lung injury

La ventilación mecánica se asocia con complicaciones importantes entre las que se encuentra la producción o perpetuación de lesión pulmonar aguda y la producción de lesión de órganos a distancia del pulmón mediante la liberación fundamentalmente de mediadores inflamatorios a la circulación sistémica. Existe cada vez mayor evidencia en modelos experimentales tanto in vitro como in vivo que demuestra la realidad de este mecanismo lesional. Los principales mecanismos lesionales son los fenómenos tanto de estiramiento y ruptura de estructuras pulmonares (volutrauma) como la apertura y cierre cíclico de zonas alveolares cerradas (atelectrauma). Los estudios acerca del empleo de estrategias ventilatorias protectoras del pulmón han demostrado un efecto beneficioso, en pacientes con síndrome de distrés respiratorio agudo (SDRA), del empleo de estrategias de ventilación a pulmón abierto, del empleo de volúmenes circulantes inferiores a 10 ml/kg y de mantener una presión alveolar inferior a 30 cm H2O. Se debe investigar si estas mismas estrategias serían útiles en prevenir la aparición de SDRA en pacientes ventilados mecánicamente por otro motivo, fundamentalmente en aquellos con factores de riesgo para el desarrollo de esta entidad

Mechanical ventilation is associated with important complications, among which production or perpetuation of acute lung injury and product of distant organ injuries of the lung basically through the release of inflammatory mediators to the systemic circulation. There is increasingly greater evidence in both in vitro and in vivo experimental models that show the reality of this lesional mechanism. The main lesional mechanisms are both stretching and rupture of the lung structures (volutrauma) and cyclical opening and closure of the closed alveolar zones (atelectrauma). Studies on the use of protective lung ventilation strategies have shown a beneficial effect in patients with ARDS of the use of open lung ventilation strategies, use of circulating volumes less than 10 ml/kg and of maintaining alveolar pressure under 30 cm of H2O. It should be investigated if these same strategies would be useful in preventing the appearance of ARDS in mechanically ventilated patients for another reason, basically in those with risk factors for the development of this condition

Biomass stabilization in the anaerobic digestion of wastewater sludges.

Sludge stabilization processes include both volatile solid destruction and biomass stabilization. Traditionally, both processes have been considered together, in such a way that, when volatile solid destruction is achieved, the biomass is considered stabilized. In this study, volatile solids reduction and biomass stabilization in the anaerobic digestion of primary, secondary and mixed sludges from municipal wastewater treatment plants were researched in batch cultures by measurements of suspended solids and suspended lipid-phosphate. The estimated kinetic constants were higher in all sludge types tested for the biomass stabilization process, indicating that volatile solids destruction and biomass stabilization are not parallel processes, since the latter one is reached before the former.

[Epidural obstetric analgesia, maternal fever and neonatal wellness parameters]. / Analgesia epidural obstétrica, fiebre materna y parámetros de bienestar neonatal.

OBJECTIVE: To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. PATIENTS AND METHODS: Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 microg x mL(-1). Data collected were age, nulliparity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. RESULTS: Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. CONCLUSIONS: Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied.

Analgesia epidural obstétrica, fiebre materna y parámetros de bienestar neonatal / Epidural obstetric analgesia, maternal fever and neonatal wellness parameters

OBJETIVO: Estudiar la relación entre la analgesia epidural y el desarrollo de fiebre materna intraparto así como la posible repercusión de tal asociación en el bienestar neonatal y en la realización de pruebas para descartar sepsis en el recién nacido. PACIENTES Y MÉTODOS: Estudio prospectivo que incluyó a todas las mujeres que dieron a luz en la Fundación Hospital Alcorcón durante 3 años. Se ofertó la administración de analgesia epidural -basada en una perfusión de bupivacaína al 0,0625% más fentanilo a 2 μg mL-1- a todas las gestantes. Se recogieron: edad, nuliparidad, administración de analgesia epidural, inducción del parto, estimulación uterina con oxitocina, tipo de parto, peso fetal, duración de la dilatación y del expulsivo, puntuación Apgar (minutos 1 y 5), pH de la arteria umbilical y temperatura materna. RESULTADOS: Se analizaron los datos de 4.364 mujeres. El 5,7% desarrolló fiebre durante el parto. El 93,7% de los casos de fiebre intraparto ocurrieron dentro del grupo de mujeres con analgesia epidural (p < 0,05). El análisis de regresión logística reveló que la analgesia epidural (OR: 1,78, IC 95%: 1,04-3,04), la nuliparidad (OR: 2,929, IC 95%: 2,005-4,279), el peso fetal (OR: 1,484, IC 95%: 1,102- 2,001) y la duración del parto (OR: 1,003, IC 95%: 1,003- 1,004) fueron factores de riesgo independientes para desarrollo de fiebre. No se encontraron diferencias en la puntuación Apgar 5 min ni en el pH arterial umbilical entre los recién nacidos de mujeres con fiebre y sin ella. El 85,1% de los recién nacidos de madres con fiebre tras analgesia epidural fue sometido a pruebas para descartar sepsis. CONCLUSIONES: La analgesia epidural se asoció con un mayor riesgo de desarrollar fiebre materna; dicha asociación no tuvo repercusión sobre los parámetros de bienestar neonatal estudiados. OBJETIVO: Estudiar la relación entre la analgesia epidural y el desarrollo de fiebre materna intraparto así como la posible repercusión de tal asociación en el bienestar neonatal y en la realización de pruebas para descartar sepsis en el recién nacido. PACIENTES Y MÉTODOS: Estudio prospectivo que incluyó a todas las mujeres que dieron a luz en la Fundación Hospital Alcorcón durante 3 años. Se ofertó la administración de analgesia epidural -basada en una perfusión de bupivacaína al 0,0625% más fentanilo a 2 μg mL-1- a todas las gestantes. Se recogieron: edad, nuliparidad, administración de analgesia epidural, inducción del parto, estimulación uterina con oxitocina, tipo de parto, peso fetal, duración de la dilatación y del expulsivo, puntuación Apgar (minutos 1 y 5), pH de la arteria umbilical y temperatura materna. RESULTADOS: Se analizaron los datos de 4.364 mujeres. El 5,7% desarrolló fiebre durante el parto. El 93,7% de los casos de fiebre intraparto ocurrieron dentro del grupo de mujeres con analgesia epidural (p < 0,05). El análisis de regresión logística reveló que la analgesia epidural (OR: 1,78, IC 95%: 1,04-3,04), la nuliparidad (OR: 2,929, IC 95%: 2,005-4,279), el peso fetal (OR: 1,484, IC 95%: 1,102- 2,001) y la duración del parto (OR: 1,003, IC 95%: 1,003- 1,004) fueron factores de riesgo independientes para desarrollo de fiebre. No se encontraron diferencias en la puntuación Apgar 5 min ni en el pH arterial umbilical entre los recién nacidos de mujeres con fiebre y sin ella. El 85,1% de los recién nacidos de madres con fiebre tras analgesia epidural fue sometido a pruebas para descartar sepsis. CONCLUSIONES: La analgesia epidural se asoció con un mayor riesgo de desarrollar fiebre materna; dicha asociación no tuvo repercusión sobre los parámetros de bienestar neonatal estudiados

OBJECTIVE: To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. PATIENTS AND METHODS: Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 μg•mL-1. Data collected were age, nulli-parity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. RESULTS: Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. CONCLUSIONS: Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied

Anaerobic digestion of dairy wastewater by inverse fluidization: the inverse fluidized bed and the inverse turbulent bed reactors.

This paper describes the application of the inverse fluidization technology to the anaerobic digestion of dairy wastewater. Two reactors were investigated: the inverse fluidized bed reactor and the inverse turbulent reactor. In these reactors, a granular floating solid is expanded by a down-flow current of effluent or an up-flow current of gas, respectively. The carrier particles (Extendospheres) were chosen for their large specific surface area (20,000 m2m(-3)) and their low energy requirements for fluidization (gas velocity of 1.5 mm s(-1), 5.4 m h(-1)). Organic load was increased stepwise by reducing hydraulic retention time from more than 60 days to 3 days, while maintaining constant the feed COD concentration. Both reactors achieved more than 90% of COD removal, at an organic loading rate of 10-12 kgCOD m(-3) d(-1), respectively. The performances observed were similar or even higher than that of other previously tested fluidized bed technologies treating the same wastewater. It was found that the main advantages of this system are: low energy requirement, because of the low fluidization velocities required; there is no need of a settling device, because solids accumulate at the bottom of the reactor, so they can be easily drawn out and particles with high-biomass content can be easily recovered. Lipid phosphate concentration has been revealed as a good method for biomass estimation in biofilms since it only includes living biomass.

[Alzheimer's caregiver burden and psychological distress. A neglected association in the assessment of dementias]. / Sobrecarga del cuidador de pacientes con enfermedad de Alzheimer y distrés psíquico. Una asociación relegada en la valoración de las demencias.

INTRODUCTION: Caregivers of dementia patients have a high risk of developing mental disorders. Nevertheless, their burden is not routinely assessed during the clinical assessment of the Alzheimer's type dementia patients. This study was designed to evaluate the association between caregiver's burden and psychological distress and to estimate the prevalence of mental disorders among the caregivers. METHODS: Cross-sectional study of Alzheimer patients' caregivers (n = 40). The caregiver burden was assessed by the Zarit scale whereas the GHQ-28 was used to evaluate psychological distress. RESULTS: The Zarit caregiver burden scale was able to discriminate the psychic distress levels (area under the curve: 0.87; 95% CI: 0.77 0.98). Its sensitivity (93%; 95% CI: 68.0 99.8) and specificity (80%; 95% CI: 59.3 93.2) were good for a cut-off point of 62/63. The estimated prevalence of psychiatric disorders in the caregivers was 20.7% (95% CI: 0.0 60.0%). CONCLUSION: The Zarit caregiver burden scale is useful for assessing psychological distress and should be included in any clinical protocol devised to evaluate the needs of patients with dementia.

Sobrecarga del cuidador de pacientes con enfermedad de Alzheimer y distrés psíquico. Una asociación relegada en la valoración de las demencias / Alzheimer's caregiver burden and psychological distress. A neglected association in the assessment of dementias

Introducción. Los cuidadores de enfermos con demencias son un grupo de alto riesgo para el desarrollo de trastornos psiquiátricos. Sin embargo, la valoración de su sobrecarga no es aún rutinaria en la evaluación clínica del paciente con demencia tipo Alzheimer. El objetivo de este estudio es valorar en nuestro medio la asociación entre distrés psíquico y sobrecarga en el cuidador de pacientes de Alzheimer y estimar la prevalencia de trastornos psiquiátricos en los cuidadores.Metodología. Estudio transversal de familiares que conviven con enfermos de Alzheimer (n = 40). La sobrecarga del cuidador se valoró con la escala de Zarit y el distrés psíquico con el GHQ-28.Resultados. La escala de Zarit presenta buena capacidad para discriminar el distrés psíquico (área bajo la curva: 0,87; IC: 95 por ciento: 0,77 - 0,98). Para un punto de corte 62/63, su sensibilidad (93 por ciento; IC: 95 por ciento: 68,0 - 99,8) y su especificidad (80 por ciento; IC: 95 por ciento: 59,3 - 93,2) son altas. La prevalencia de trastornos mentales estimada en los cuidadores es del 20,7 por ciento (IC: 95 por ciento: 0,0 - 60 por ciento).Conclusiones. La escala de sobrecarga del cuidador de Zarit es útil en nuestro medio para valorar distrés psíquico, y debería estar incluida en todo protocolo de valoración clínica de enfermos con demencia (AU)

[How many patients need treatment for hypercholesterolemia?]. / Cuántos pacientes precisan tratamiento para la hipercolesteremia?

OBJECTIVE: To find out the percentage of individuals from a population who need pharmacologic treatment for their hypercholesterolemia according to different guidelines. DESIGN: Descriptive transversal study. SETTING: Population from 6 areas of Lleida (province) including the city of Lleida. METHOD: The study has been done on a randomized sample of 401 individuals. First the cardiovascular risk from the equation in the Framingham study was calculated, then the percentage of individuals who should be treated with lipid-lowering medication according to the US National Cholesterol Education Program, The European Society of Atherosclerosis and The Spanish Society of Atherosclerosis. RESULTS: The prevalence of individuals with cholesterolemia > 250 mg/dl has been 16.3% among men and 22.4% in women. According to NCEP, 20.5% of men and 17.6% of women from 383 individuals older then 6 years old need pharmacologic treatment for hypercholesterolemia. The Framingham equation was applied to 281 individuals (over 30 and under 75 years old) estimating a risk higher than 20% in 10 years for 13.7% of the population under study (23.9% in men and 3.5% in women). CONCLUSIONS: The percentage of patients who need pharmacologic treatment for hypercholesterolemia varies according to the different guidelines employed. We consider necessary the calculation of the cardiovascular risk with the Framingham equation to use lipid-lowering medication in order to achieve a better protection of the population at higher risk of developing a cardiovascular disease.

¿Cuántos pacientes precisan tratamiento para la hipercolesteremia? / How many patients need treatment for hypercholesterolemia?

Objetivo. Calcular el porcentaje de individuos de una población que precisa tratamiento farmacológico según las diferentes guías para el tratamiento de la hipercolesteremia. Diseño. Estudio descriptivo transversal. Emplazamiento. Población de 6 comarcas de Lleida: cinco pirenaicas y una en el llano, donde se emplaza la capital de la provincia. Método. En 401 individuos procedentes de una muestra aleatoria de 6 comarcas de Lleida se calculó el riesgo cardiovascular según la tabla de cálculo del estudio de Framingham y el porcentaje de individuos que precisan fármacos hipolipemiantes según el US National Cholesterol Education Program, la Sociedad Europea de Aterosclerosis y la Sociedad Española de Aterosclerosis. Resultados. La prevalencia de individuos con colesterol total > 250 mg/dl fue del 16,2 por ciento en los varones y del 22,4 por ciento en las mujeres. Precisaban tratamiento farmacológico para la hipercolesteremia un 20,5 por ciento de los varones y un 17,6 por ciento de las mujeres de los 383 individuos mayores de 6 años de la población, según el NCEP. La ecuación de Framingham se aplicó a 281 individuos (mayores de 30 y menores de 75 años); estima un riesgo superior al 20 por ciento en 10 años en un 13,7 por ciento de la población, siendo de un 23,9 por ciento en los varones y un 3,5 por ciento en las mujeres. Conclusiones. El porcentaje de pacientes que precisa tratamiento farmacológico para la hipercolesteremia varía según las diferentes guías utilizadas. Consideramos necesario el cálculo del riesgo cardiovascular según la ecuación de Framingham en el uso de fármacos para que éste se ajuste a la población con mayor riesgo, dado el origen multifactorial de la enfermedad cardiovascular (AU)

An aromatic L-amino acid decarboxylase inhibitor blocks L-dopa-induced air-stepping in neonatal rats.

Rat pups suspended in air and administered L-DOPA engage in a locomotor behavior termed air-stepping. The role of L-DOPA itself was investigated by administering several doses of an aromatic L-amino acid decarboxylase inhibitor, NSD 1015, prior to 100 mg/kg L-DOPA to 5-day-old rats. NSD 1015 dose-dependently increased the latency to onset and decreased the duration of L-DOPA-induced air-stepping. Thus L-DOPA induces air-stepping only after its conversion to dopamine and/or noradrenaline.