Seroprevalence of trypanosomosis and associated risk factors in cattle from coast and amazonian provinces of Ecuador.

Trypanosomosis is a tropical disease caused by various protozoan haemoparasites, which affects wild and domestic animals, the latter ones related to worldwide livestock production systems. Species such as Trypanosoma vivax and Trypanosoma evansi have been described using serological and molecular tools in several countries from South and Central America. However, Ecuador presents a relevant knowledge gap in the associated general epidemiology and risk factors of the disease. Therefore, the objective of this study was to determine the seroprevalence of trypanosomosis in cattle from different regions of Ecuador. 745 serum samples from 7 Coastal and 3 Amazon provinces were screened for IgG anti-Trypanosoma spp. antibodies, using an in-house indirect ELISA. The seropositivity was explored and associated with several variables such as sex, age, breed, region, management, and province, using statistical tools. The general seroprevalence of trypanosomosis was 19.1% (95% CI: 16.30-22.1%). The Amazonian provinces of Sucumbíos and Napo and the Coastal province of Esmeraldas presented the highest seroprevalence values of 36.7% (95% CI: 27.67-46.47%), 23.64% (95% CI: 16.06-32.68%) and 25% (95% CI: 15.99-35.94%), respectively. Statistical significance was found for the region, province, and management variables, indicating as relevant risk factors the extensive management and Amazon location of the cattle analyzed. Specific actions should be taken to identify the exact species on reservoirs and susceptible hosts, evaluate the implication of farm management and cattle movement as risk factors, and implement surveillance and treatment plans for affected herds.

Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage

Objective: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH. Design: A prospective, observational cohort study. Setting: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). Patients: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. Interventions: None. Main variables: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. Results: A total of 37 patients (24%) received AT. These subjects were older (69±11 vs. 60±15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm3, p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT. Conclusions: Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT (AU)

Objetivo: Con el envejecimiento progresivo de la población cada es más frecuente la toma de fármacos antiagregantes para el tratamiento o la prevención de las enfermedades vasculares. El beneficio, en ocasiones, está contrarrestado por el riesgo de hemorragias, especialmente la hemorragia intracraneal (HIC). Nuestro objetivo fue determinar si el tratamiento antiagregante (TAG) provoca un aumento del tamaño del hematoma y de mortalidad en la HIC. Diseño: Estudio de cohortes prospectivo y observacional. Ámbito: Unidad de cuidados intensivos (UCI) del Hospital Universitario Virgen de la Arrixaca (Murcia). Pacientes: Estudiamos a 156 pacientes que ingresaron por HIC no traumática entre Enero de 2006 y Agosto de 2008. Intervenciones: Ninguna. Principales variables: Se recogieron datos demográficos, antecedentes personales, parámetros clínicos y analíticos, así como, el volumen del hematoma al ingreso y a las 24 horas, además de la mortalidad. Resultados: Entre los pacientes estudiados, 37 (24%) tomaban TAG. Los antiagregados eran de mayor edad (69±11 vs 60±15 años, p=0,001) y con mayor frecuencia diabéticos (38 vs 15%, p=0,003). No hubo diferencias en el volumen del hematoma al ingreso entre los dos grupos pero este fue significativamente mayor a las 24 horas en los antiagregados (66.7 [IQR 42-110] vs 27 [4.4-64.6] cm3, p=0.03), independientemente de si fueron intervenidos o no. Además, el volumen del hematoma creció en más de un 33% en los antiagregados (69 vs 33%, p=0,002) y el TAG fue el único predictor significativo del crecimiento (..) (AU)

Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage.

OBJECTIVE: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH. DESIGN: A prospective, observational cohort study. SETTING: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). PATIENTS: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. INTERVENTIONS: None. MAIN VARIABLES: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. RESULTS: A total of 37 patients (24%) received AT. These subjects were older (69 ± 11 vs. 60 ± 15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm(3), p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT. CONCLUSIONS: Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT.

[Technical and functional standards and implementation of a clinical information system in intensive care units]. / Estándares técnicos y funcionales, y proceso de implantación, de un sistema de información clínica en unidades de cuidados intensivos.

INTRODUCTION: Clinical Information Systems (CIS) are becoming a useful tool for managing patients and data in the ICU. However, the existing CIS differ in their capabilities and technical requirements. It is therefore essential for intensivists, as the end clients of these applications, to define the suitable minimum specifications required in order to be operative and helpful. OBJECTIVES: The Spanish Society of Intensive Care Medicine and Coronary Units, through its Organization and Management Workgroup, has designated a group of clinical and software experts to draft a document with the recommendable technical and operating requirements of these systems. METHODS: The group was formed by ten people supported by managers or engineers from the five principal industries producing CIS in Spain. The project involved the following phases: a) Completion of a check list. This step was considered necessary in order to establish the precise current situation of CIS applications. b) Discussion of the results by the group of experts in a meeting and in online format. RESULTS: The requirements were grouped into four sections: technical, functional, safety and data management. All requirements were classified as basic and optional in order to allow the end user to choose among different options according to the existing budget, though ensuring a minimal set of useful characteristics. A chronogram for the installation process was also proposed.

[Weaning failure in mechanical ventilation. Ondine's curse: a clinical case and review]. / Fracaso en el destete de la ventilación mecánica. La maldición de Ondine: caso clínico y revisión.

Cerebral lesions after a stroke present different clinical features depending on the neurological structures affected. Complications after an injury in the respiratory center may lead to prolonged mechanical ventilation. Among these possible complications there is a rare neurological condition called "Ondine's curse" that is caused by spontaneous breathing failure. Patients who suffer this syndrome cannot breathe automatically and need to control their respiration consciously and voluntarily. We report the case of a woman who developed a syndrome of central alveolar hypoventilation secondary to an injury in respiratory center after a hemorrhagic stroke. We have reviewed the etiology, physiopathology, diagnosis and treatment of patients with Ondine's curse.

Fracaso en el destete de la ventilación mecánica. La maldición de Ondine: caso clínico y revisión / Weaning failure in mechanical ventilation. Ondine's curse: A clinical case and review

Las lesiones cerebrales secundarias a un ictus se manifiestan según la estructura neurológica afectada. Las complicaciones por afectación del centro respiratorio pueden ser causa de una ventilación mecánica prolongada. Entre estas complicaciones se encuentra la llamada «maldición de Ondine», que hace referencia a una rara enfermedad neurológica causada por el fallo en la respiración espontánea. Los pacientes no son capaces de respirar automáticamente, y necesitan consciente y voluntariamente realizar la respiración por ellos mismos. En este artículo presentamos el caso de una mujer que tras un ictus hemorrágico cerebeloso desarrolla un síndrome de hipoventilación alveolar central secundario a una lesión del centro respiratorio. Realizamos una revisión de la etiología, el mecanismo fisiopatológico, el diagnóstico y el tratamiento del síndrome de Ondine (AU)

Cerebral lesions after a stroke present different clinical features depending on the neurological structures affected. Complications after an injury in the respiratory center may lead to prolonged mechanical ventilation. Among these possible complications there is a rare neurological condition called «Ondine's curse» that is caused by spontaneous breathing failure. Patients who suffer this syndrome cannot breathe automatically and need to control their respiration consciously and voluntarily. We report the case of a woman who developed a syndrome of central alveolar hypoventilation secondary to an injury in respiratory center after a hemorrhagic stroke. We have reviewed the etiology, physiopathology, diagnosis and treatment of patients with Ondine's curse (AU)

Intervención para la disminución de las estancias inapropiadas. Un estudio de tres años en un hospital universitario. Evaluación mediante el empleo del Appropriateness Evaluation Protocol (AEP) / Intervention for lowering inappropriate stays. A 3-years study at an university hospital. Evaluation by means of the employment of the Appropriateness Evaluation Protocol (AEP)

Objetivo: Evaluación de la intervención para disminuir las estancias inapropiadas, estudiando las características de los procesos de los servicios con mayor proporción de las mismas y analizando los resultados obtenidos. Métodos: Estudio concurrente de 569 estancias distribuidas entre los años 2000 a 2002, escogidas mediante muestreo de bloques durante un día único. Se estudia la proporción de estancias inadecuadas para un conjunto de servicios con mayor impacto en la inadecuación de las estancias. Se comparan las proporciones de inadecuación entre las diferentes unidades del hospital y entre los diferentes años. Se estudian los procesos de los dos servicios más desviados y se corrigen determinados defectos en la organización y estructura de éstos. Resultados: En los servicios quirúrgicos la inadecuación global fue del 71,4 por ciento y en los médicos el 70,7 por ciento. La proporción de adecuación global de la estancia varió desde el 70,07 por ciento del año 2000 al 73,06 por ciento del año 2002. La proporción de estancias inadecuadas en los servicios donde se realiza la intervención desciende un 30 por ciento y un 75 por ciento (desde el 47,6 al 33,3 por ciento y del 42,1 al 10,5 por ciento). La causa mas frecuente de inadecuación de la estancia es encontrarse pendiente de resultados y la posibilidad de realizar determinadas pruebas como paciente externo. Conclusiones: El análisis secuencial de la utilización de recursos mediante el AEP (Appropriateness Evaluation Protocol) permite evaluar y corregir defectos organizativos y de la distribución de los recursos. La selección de determinados servicios con niveles mas altos de inadecuación permite focalizar el problema y las soluciones. En nuestro medio la causa corregible más importante fue la mala distribución del horario de algunas pruebas que provocaba estancias inapropiadas y la estancia de pacientes para realizar pruebas que podrían realizarse de forma ambulatoria (AU)

[Ethics conflicts in the application of mechanical ventilation: analysis of the attitude of critical care and emergency professionals and students]. / Conflictos éticos en la instauración de la ventilación mecánica: análisis de la actitud de profesionales de cuidados críticos, emergencia y estudiantes.

OBJECTIVE: To analyze the influence of prognosis, life quality or previous instructions in the decision making of applying an invasive (intubation/mechanical ventilation), conservative or palliative procedure. MATERIAL AND METHODS: "Casuistry" methodology: opinion on the appropriate decision regarding five clinical histories representative of ethic conflicts with 542 health professionals (220 intensive care specialist, 150 emergency department professionals, 76 nurses, and 96 students). As control group, 26 students enrolled in a International Master on Bioethics. RESULTS: A great inter-group variability was observed (p = 0.005) with a higher agreement with control group between students and lower with intensivists. The agreement observed was highest in cases with "total support" as the appropriate option (kappa 0.85, 0.69, and 0.66) than in cases with "palliative measures" as appropriate option (kappa 0.22 and 0.46). CONCLUSIONS: 1) A high variability was observed regarding decisions on instituting respiratory support. 2) Decisions regarding the restriction of therapeutic efforts are not accepted in the main, even in scenarios merging into futility, as permanent vegetative status. 3) Among severely deteriorated and handicapped patients, perceived life quality is more appreciated by the patient than that estimated objectively. 4) There is no a consensus opinion for the respect of previous guidelines of vital support refusal. 5) Age and deep psychic deficiency are not considered as cause of discrimination. These features may be considered typical of the mediterranean ethics, in which paternalism and charity are more appreciated values than autonomy.

Conflictos éticos en la instauración de la ventilación mecánica: análisis de la actitud de profesionales de Cuidados Críticos, Emergencia y estudiantes / Ethic conflicts regarding the institution of mechanical ventilation: analysis of the attitudes of critical care emergency professionals and students

Objetivo. Analizar la influencia del pronóstico, calidad de vida o instrucciones previas en la decisión de aplicar procedimiento invasivo (intubación/ventilación mecánica), conservador o paliativo. Metodología casuística: opinión sobre la decisión adecuada ante 5 historias representativas de conflictos éticos de 542 profesionales (220 intensivistas, 150 emergenciólogos, 76 enfermeras y 96 alumnos). Como grupo control, 26 alumnos de un Máster Internacional de Bioética. Resultados. Se observa gran variabilidad intergrupos (p = 0,005), con mayor coincidencia con el grupo control entre los alumnos y menor en los intensivistas. La concordancia es más elevada en los casos en que la opción adecuada es soporte total (Kappa 0,85, 0,69 y 0,66) que cuando lo apropiado es medidas paliativas (Kappa 0,22 y 0,46). Conclusiones. 1) Se observa una gran variabilidad en las decisiones sobre instauración de soporte respiratorio.2) Las decisiones de limitación del esfuerzo terapéutico no son mayoritariamente aceptadas, incluso en escenarios que entran en el terreno de la futilidad, como el estado vegetativo permanente. 3) En enfermos muy evolucionados y con grandes limitaciones se valora más la calidad de vida percibida por el paciente que la estimada objetivamente. 4) No existe una opinión mayoritaria por el respeto de directrices previas de rechazo al soporte vital.5) No son tenidas en cuenta la edad y la deficiencia psíquica profunda como causa de discriminación. Estos rasgos quizá puedan considerarse característicos de la ética mediterránea, en la que el paternalismo y la beneficencia constituyen valores más apreciados que la autonomía (AU)