Systemic Inflammation Differences in Brain-vs. Circulatory-Dead Donors: Impact on Lung Transplant Recipients.

Brain death triggers a systemic inflammatory response. Whether systemic inflammation is different in lung donors after brain- (DBD) or circulatory-death (DCD) is unknown, but this may potentially increase the incidence of primary graft dysfunction (PGD) after lung transplantation. We compared the plasma levels of interleukin (IL)-6, IL-8, IL-10 and TNF-α in BDB and DCD and their respective recipients, as well as their relationship with PGD and mortality after LT. A prospective, observational, multicenter, comparative, cohort-nested study that included 40 DBD and 40 DCD lung donors matched and their respective recipients. Relevant clinical information and blood samples were collected before/during lung retrieval in donors and before/during/after (24, 48 and 72 h) LT in recipients. Incidence of PGD and short-term mortality after LT was recorded. Plasma levels of all determined cytokines were numerically higher in DBD than in DCD donors and reached statistical significance for IL-6, IL-10 and IL-8. In recipients with PGD the donor's plasma levels of TNF-α were higher. The post-operative mortality rate was very low and similar in both groups. DBD is associated with higher systemic inflammation than DCD donors, and higher TNF-α plasma levels in donors are associated with a higher incidence of PGD.

[Sexuality in older women]. / Sexualidad en las mujeres mayores.

OBJECTIVES: To determine the prevalence of sexual relations in women >or=65 years. To determine factors that affect their activity and interest in sex. To evaluate the impact on their quality of life. DESIGN. Descriptive, cross-sectional study by means of survey. SETTING: Palacio de Segovia Health Centre, Madrid, Spain. Primary care. PARTICIPANTS: Women >or=65 years old. Criteria of exclusion: bed-ridden women, with psychiatric disease and/or moderate-severe cognitive deterioration. Sequential selection from 10 medical lists. MAIN MEASUREMENTS: Social and demographic, medical, geriatric (Katz and Lawton-Brody index), quality of life (WONCA sheets), variables on sexuality. RESULTS: One hundred and sixty two women. Mean age, 74.7 (7.8). Sixty one women with a stable partner (37.7%). Thirty four maintained sexual relations (20.98%), 61.8% (21) of them with coitus: these were satisfactory for 29 women (85.3%). For 50 (30.8%), communication was the most important aspect of sexuality. The lower their age, the more sexual relations they had (P<.022; odds ratio [OR]=0.85; 0.74-0.97). Of 115 women satisfied with the relations of their youth, 28.7% maintained sexual relations now (P<.003; OR=17; 1.7-178.8). The 23.9% maintained their sexual desire, though their partners had more interest in sex (50.9%). Women with stable partners and high self-esteem had more sexual relations than those who had neither, with a significant difference in both cases (P<.001). Maintaining sexual relations is a dependent factor on the Katz index (P<.007). The 32.2% of women thought that their sex life had changed for the worse, while 30.12% (20.54+19.17) thought their sex life had not changed or had improved. CONCLUSIONS: One of every 4 women >64 years old maintain sexual relations. Factors that determine sexual activity are: self-esteem, having a partner, sexual desire, previous sexual history, and the Katz index. Sexual relations are independent of quality of life.

Sexualidad en las mujeres mayores / Sexuality in older women

Objetivos. Determinar la prevalencia de relaciones sexuales en mujeres mayores de 64 años, los factores que condicionan su actividad e interés sexual y valorar el impacto en su calidad de vida. Diseño. Estudio descriptivo, transversal, mediante encuesta. Emplazamiento. Centro de salud Palacio de Segovia (Madrid). Atención primaria. Participantes. Mujeres mayores de 64 años. Criterios de exclusión: mujeres encamadas, con enfermedad psiquiátrica y/o deterioro cognitivo moderado-severo. Selección secuencial en 10 cupos médicos. Mediciones principales. Variables sociodemográficas, médicas, geriátricas (índice de Katz, Lawton-Brody), calidad de vida (láminas WONCA), variables sobre sexualidad. Resultados. Se incluyó a 162 mujeres. Edad media de 74,7 ± 7,8 años. En total, 61 mujeres tenían pareja estable (37,7%). Mantienen relaciones sexuales 34 (20,98%), el 61,8% (21) de ellas, coitales, que son satisfactorias para 29 (85,3%). Para 50 (30,8%) establecer una comunicación es el elemento más importante de la sexualidad. A menor edad, más relaciones (p < 0,022; odds ratio [OR] = 0,85; 0,74-0,97). De las 115 mujeres satisfechas con las relaciones de su juventud, un 28,7% mantiene relaciones en la actualidad (p < 0,003; OR = 17; 1,7-178,8). El 23,9% mantiene el deseo sexual, aunque presentan más interés sexual sus parejas (50,9%). Las mujeres con pareja estable y autoestima elevada mantienen más relaciones sexuales (p < 0,001). Mantener relaciones sexuales es un factor dependiente del índice de Katz (p < 0,007). El 32,2% de las mujeres piensa que su vida sexual ha cambiado a peor, mientras que para el 30,12% de las mujeres del estudio (20,54 + 19,17) su vida sexual no ha cambiado o lo ha hecho para mejorar. Conclusiones. Mantiene relaciones sexuales una de cada 4 mujeres mayores de 64 años. Los factores que condicionan la actividad sexual son la autoestima, tener pareja, el deseo sexual, la historia sexual previa y el índice de Katz. Las relaciones sexuales son independientes de la calidad de vida

Objectives. To determine the prevalence of sexual relations in women é65 years. To determine factors that affect their activity and interest in sex. To evaluate the impact on their quality of life. Design. Descriptive, cross-sectional study by means of survey. Setting. Palacio de Segovia Health Centre, Madrid, Spain. Primary care. Participants. Women é65 years old. Criteria of exclusion: bed-ridden women, with psychiatric disease and/or moderate-severe cognitive deterioration. Sequential selection from 10 medical lists. Main measurements. Social and demographic, medical, geriatric (Katz and Lawton-Brody index), quality of life (WONCA sheets), variables on sexuality. Results. One hundred and sixty two women. Mean age, 74.7 (7.8). Sixty one women with a stable partner (37.7%). Thirty four maintained sexual relations (20.98%), 61.8% (21) of them with coitus: these were satisfactory for 29 women (85.3%). For 50 (30.8%), communication was the most important aspect of sexuality. The lower their age, the more sexual relations they had (P64 years old maintain sexual relations. Factors that determine sexual activity are: self-esteem, having a partner, sexual desire, previous sexual history, and the Katz index. Sexual relations are independent of quality of life

[Variable measurement in urologic clinical research]. / La medición de las variables en la investigación clínica urológica.

Epidemiology develops measurements that allow to quantify the occurrence of disease within the population. There are three types of measurements: frequency measurements, explained in this article; association measurements, between the occurrence of disease and some characteristics, the effect of which on the disease is what they intend to measure; and measurements of the potential impact that modification or disappearance of some risk factors would have on the occurrence of disease in the population. The first objective of epidemiological studies is the knowledge of the frequency of disease. There are three basic measurements of frequency of a disease. Prevalence measures the proportion of people that has it in a given moment. Cumulative incidence measures the proportion of people that convert from non-sick individual to sick individual during a specified period of time. Incidence rate is a measure of the instantaneous strength of occurrence of the disease.

[Statistics as support tool and not as a decision tool]. / La estadística como una herramienta de apoyo y no como una herramienta de decisión.

The use of statistics in medical articles has risen a lot during the last decades, however it is used in a thoughtless manner in many instances. Today, Statistics is the only tool that allows the medical researcher to obtain results and benefits from those studies the relationships of which can not be interpreted from a determinist perspective, because it is a branch of applied mathematics objective of which is to manage and quantify the uncertainty of the available information, to support decision taking. The objective of this article is to review the basic statistical concepts that every doctor should know to be able to perform and/or detect quality research, as well as to underline the most frequent errors committed when interpreting statistical results. We review the general concepts about data synthesis and differentiation of the different types of measurements, hypothesis testing and errors that can be committed doing it, the real meaning of the "p" value, differentiation between statistically significant and clinically relevant results, the importance of confidence intervals as a measure of significance and clinical relevance, the confusion generated between two concepts that are different as standard deviation and standard error, and the criteria that govern the selection of the adequate statistical tests to evaluate relationships between variables.

[Writing an original research article]. / Elaboración de un artículo original de investigación.

Publication of a scientific work is the final and obligatory stage of any research. Among the various existing types of medical publications, the research original article is the prototype of scientific article. Its finality is to communicate the investigation undertaken to the reader in a coherent, clear and precise manner. With that purpose, the discoveries found by the authors as an answer to a hypothesis are presented and discussed. To send the original article to a biomedical journal, the manuscript should present some adequate formal characteristics, in addition to contain scientifically valid information. That can be achieved by complying with the rules past by the International Committee of Biomedical Journal Editors which have been adopted by a great number of scientific journals as publication requisites. The objective of this article is to describe the structure of the various parts (first page, abstract, introduction, material and methods, results, discussion, and bibliographic references) that constitute the format of the research original article, exposing the main adverse to be avoided during its preparation.

La estadística como una herramienta de apoyo y no como una herramienta dedecisión / Statistics as a support tool and not as a decision tool

El uso de la estadística en los artículos médicos se ha incrementado mucho en las últimas décadas, utilizándose, sin embargo, en muchas ocasiones, de un modo irreflexivo. La estadística es, hoy por hoy, la única herramienta que permite al investigador médico obtener resultados y beneficios en aquellos estudios cuyas relaciones no puedan ser interpretadas desde una perspectiva determinista, puesto que es una rama de las matemáticas aplicadas cuya finalidad es manejar y cuantificar la incertidumbre de la información disponible, para apoyar la toma de decisiones. El objetivo de este artículo es repasar los conceptos estadísticos básicos que todo médico debe conocer, para poder realizar y/o detectar una investigación de calidad, así como subrayar los errores que con más frecuencia se cometen al interpretar los resultados estadísticos. Se abordan conceptos generales acerca de la síntesis de datos y la diferenciación de los distintos tipos de medidas, el contraste de hipótesis y los errores que pueden cometerse al realizarlo, el verdadero significado del valor "p", la distinción entre un resultado estadísticamente significativo y clínicamente relevante, la trascendencia del intervalo de confianza como medida de significación y de relevancia clínica, la confusión que se genera entre dos conceptos distintos como son la desviación estándar y el error estándar y los criterios que rigen la elección de la prueba estadística adecuada al evaluar la relación entre variables. (AU)

La medición de las variables en la investigación clínica urológica / The measurement of variables in clinical research in urology

La epidemiología desarrolla medidas que permiten cuantificar la ocurrencia de la enfermedad en la población. Existen tres tipos de medidas: medidas de frecuencia, explicadas en este artículo; de asociación, entre la ocurrencia de enfermedad y determinadas características, cuyos efectos sobre la enfermedad es lo que se pretenden medir; y medidas del impacto potencial que tendría en la población la modificación o desaparición de determinados factores de riesgo sobre la ocurrencia de enfermedad. El conocimiento de la frecuencia de enfermedad es el primer objetivo en los estudios epidemiológicos. Existen tres medidas básicas de frecuencia de una enfermedad. La prevalencia mide la proporción de gente que tiene la enfermedad en un instante concreto. La incidencia acumulada mide la proporción de gente que se convierte, durante un periodo de tiempo especificado, de no enfermo en enfermo. La tasa de incidencia es una medida de la fuerza instantánea de ocurrencia de la enfermedad (AU)

Elaboración de un artículo original de investigación / Elaboration of a research original article

La publicación de un trabajo científico es la etapa final y obligada de cualquier investigación. Entre los distintos tipos de publicaciones médicas existentes, el artículo original de investigación es el prototipo de artículo científico. Su finalidad es comunicar al lector de forma coherente, clara y precisa la investigación llevada a cabo. Para ello se presentan y discuten los hallazgos encontrados por los autores en respuesta a una hipótesis.Para enviar el artículo original a una revista biomédica, el manuscrito, además de contener una información científicamente válida, debe presentar unas adecuadas características formales. Ello se consigue cumpliendo las normas aprobadas por el Comité Internacional de Editores de Revistas Biomédicas que han sido adoptadas por gran número de revistas científicas como requisitos de publicación.El objetivo de este artículo es describir la estructura de los diferentes apartados (primera página, resumen, introducción, material y métodos, resultados, discusión y referencias bibliográficas) que constituyen el formato del artículo original de investigación, exponiendo los principales errores a evitar en su elaboración (AU)