Hyperlacticaemia in children with status asthmaticus. The Stewart approach.

BACKGROUND: Patients with status asthmaticus (SA) frequently present with lactic acidosis (LA). Our goal is to identify the nature of this LA using the Stewart physicochemical model and to identify the independent factors associated with LA in children with SA. METHODS: Analytical study of a retrospective cohort using a nested case-control design. Twenty-eight episodes of SA in 24 children were included. Patients admitted to a paediatric intensive care unit (PICU) for SA over a 9-year period were recruited consecutively. Data were analysed using the Stewart model and the Strong Ion Calculator. Data were analysed using descriptive statistics and regression models were fitted within the general linear model. RESULTS: Hyperlacticaemia (Lact[mM/L] = 3.905 [95% CI = 3.018-4.792]) and acidosis (pH = 7.294 [95% CI = 7.241-7.339]) were observed in 18 episodes (15 patients; 62.5%). According to the Stewart model, acidosis was caused by a decrease in strong ion difference. Initially, pCO2 was high (pCO2[mmHg] = 45.806 [95% CI = 37.314-54.298]) but the net unmeasured ion (NUI) component was normal (NUI = -4,461 [95% CI = -3.51 to -5.412]), and neither changed significantly over the clinical course. There was no need to determine pyruvate, as the NUI was normal and the LA was type B (non-hypoxic, lactate/pyruvate < 25). We observed a correlation (P = .023) between LA and intramuscular epinephrine administered on arrival at hospital, but not between LA and the cumulative dose of nebulized salbutamol. CONCLUSIONS: Most patients with SA presented LA. The Stewart model confirmed that LA is not hypoxic, probably due to sympathomimetic-related glycolysis.

Adscripción del farmacéutico a cuidados intensivos: generando sinergias / Pharmacist Adscription To Intensive Care: Generating Synergies

OBJETIVO: Evaluar la incorporación de un farmacéutico de hospital a la actividad habitual de una unidad de cuidados intensivos (UCI). DISEÑO: Estudio observacional prospectivo para evaluar las intervenciones farmacéuticas, realizadas por un farmacéutico adscrito temporalmente a una UCI, sobre las prescripciones médicas. Ámbito: UCI médico-quirúrgica con 21 camas. PACIENTES: Se incluyeron los pacientes con al menos una estancia en UCI y se excluyeron los pacientes con ingreso y alta en periodos en los que no se contó con la presencia física del farmacéutico. INTERVENCIONES: Se realizaban tras la revisión diaria de las prescripciones y se comunicaban de forma verbal o escrita al médico responsable. Variables principales: Intervenciones realizadas, grupo terapéutico de los medicamentos implicados, forma de realización de la intervención y el grado de aceptación. RESULTADOS: Se realizaron 194 intervenciones en 62 pacientes. La mayoría estaban relacionadas con aspectos de seguridad (33%) y optimización de la terapia (32%). Las más frecuentes se dirigieron a la administración de medicamentos por sonda nasogástrica (19%) y a la monitorización farmacocinética (14,4%). Los grupos de medicamentos más implicados fueron los antiinfecciosos en un 33% de los casos y los del aparato digestivo en un 27%. El 56,2% de las intervenciones se realizaron verbalmente y el 80% fueron aceptadas. CONCLUSIONES: La adscripción de un farmacéutico a una UCI y la realización de intervenciones sobre las prescripciones han permitido mejorar la seguridad y optimizar la farmacoterapia en más de la mitad de los pacientes. La alta tasa de aceptación de las mismas apoyaría la implementación de este tipo de programas en las unidades de críticos

OBJECTIVE: To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU). DESIGN: A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. SETTING: A medical and surgical ICU with 21 beds. PATIENTS: Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. INTERVENTIONS: The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. MAIN VARIABLES: Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. RESULTS: A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. CONCLUSIONS: Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units

Assessment of Sensory Processing and Executive Functions in Childhood: Development, Reliability, and Validity of the EPYFEI.

The aim of this study was to determine the psychometric properties of the "Assessment of Sensory Processing and Executive Functions in Childhood" (EPYFEI), a questionnaire designed to assess the sensory processing and executive functions of children aged between 3 and 11 years. The EPYFEI was completed by a sample of 1,732 parents of children aged between 3 and 11 years who lived in Spain. An exploratory factor analysis was conducted and showed five main factors: (1) executive attention, working memory, and initiation of actions; (2) general sensory processing; (3) emotional and behavioral self-regulation; (4) supervision, correction of actions, and problem solving; and (5) inhibitory. The reliability of the analysis was high both for the whole questionnaire and for the factors it is composed of. Results provide evidence of the potential usefulness of the EPYFEI in clinical contexts for the early detection of neurodevelopmental disorders, in which there may be a deficit of executive functions and sensory processing.

Pharmacist Adscription To Intensive Care: Generating Synergies. / Adscripción del farmacéutico a cuidados intensivos: generando sinergias.

OBJECTIVE: To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU). DESIGN: A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. SETTING: A medical and surgical ICU with 21 beds. PATIENTS: Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. INTERVENTIONS: The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. MAIN VARIABLES: Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. RESULTS: A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. CONCLUSIONS: Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units.

Percepción y realidad del uso de WhatsApp en estudiantes universitarios de ciencias de la salud / Perception and reality of WhatsApp use in health sciences students

Objetivos: Analizar si existen diferencias entre la percepción que los estudiantes universitarios tienen sobre el uso de WhatsApp y los datos reales, y explorar alguna posible asociación entre la intensidad de uso de esta herramienta social y el rendimiento académico. Sujetos y métodos: La investigación, de alcance observacional y naturaleza cuantitativa, se llevó a cabo con la participación de 81 estudiantes de ciencias de la salud de la Universidad de Málaga (España) matriculados en el grado en terapia ocupacional. Se utilizó una encuesta para recopilar información sobre la percepción del uso de herramientas sociales y, adicionalmente, se utilizaron dos instrumentos para recopilar información real sobre el uso de herramientas sociales: en primer lugar, el registro de mensajes en la aplicación WhatsApp; en segundo lugar, la herramienta de monitorización de actividades denominada RescueTime. A través de estas herramientas se obtuvieron datos como el número exacto de los mensajes enviados y recibidos a través de WhatsApp durante un período, así como el tiempo diario dedicado a WhatsApp, Facebook, correo electrónico, páginas web específicas, herramientas de oficina y otras aplicaciones. Resultados y conclusiones: Entre los resultados se encontró que, sin importar sexo, desempeño académico o curso, WhatsApp es la aplicación más utilizada por la mayoría de los participantes del estudio. La percepción de los estudiantes es que utilizan mucho más WhatsApp de lo que en realidad lo hacen. No se encontró una asociación lineal entre intensidad de uso de WhatsApp y desempeño académico

Aims: To analyze if there are differences between the perception that college students have about using WhatsApp and real data, and also to explore a possible association between the intensity of use of these social tools and academic achievement. Subjects and methods: The research was exploratory and quantitative nature, with the participation of 81 Health Sciences students of the University of Malaga (Spain), enrolled in Occupational Therapy Degree. A survey was used for collecting information about the perception of the use of social tools and, in addition, two instruments were used to collect real information about the use of social tools: firstly, the message log in the WhatsApp application. Secondly, a monitoring tool of activities called RescueTime. These tools provided the exact number of messages sent and received via WhatsApp for a period of time, as well as the daily time spent on WhatsApp, Facebook, email, specific Web pages, office tools and other applications. Results and conclusions: The results showed that, regardless of gender, academic achievement or course, WhatsApp is the most used application by the majority of participants. The perception of WhatsApp's use is higher for the student than real use of WhatsApp. A lineal association between intensity of WhatsApp's use and academic achievement was not found

Impacto de un programa de prescrición prudente en residentes de centros sociosanitarios / Impact of a program of conservative prescription in nursing homes

Introducción: El paciente anciano es más susceptible a efectos negativos a la medicación consecuencia de interacciones medicamentosas, de reacciones adversas y de prescripciones potencialmente inapropiadas (PPI). Objetivo: Analizar la influencia de un sistema estandarizado de revisión de tratamientos sobre el número de PPI y de medicamentos que forman parte del la tratamiento crónico. Se analizarán los resultados clínicos. Metodo: Estudio prospectivo de tres meses de duración en el que se revisaron los tratamientos de residentes de dos centros sociosanitarios. Se realizó una primera revisión tomándose las decisiones farmacoterapéuticas correspondientes. Al mes, en una segunda revisión, se analizó si las decisiones tomadas tuvieron una repercusión negativa en el estado de salud de los residentes. Variables analizadas: número de medicamentos/residente y número de PPI/residente al principio y final del estudio, tipo de PPI y resultado clínico (sin repercusión negativa, síndrome de retirada, reaparición de síntomas). Resultados: Se revisaron 332 tratamientos, identificándose 380 PPI. Se redujo de manera significativa el número medio de PPI/residente de 1,14 a 0,52 (diferencia de medias; -0,63 IC95% [-0,49, -0,76]). El número medio de medicamentos/residente se redujo de 8,76 a 8,32 (diferencia de medias; -0,44 IC95% [0,17, -1,05]) siendo la diferencia estadísticamente no significativa. En tres residentes la retirada del medicamento resultó en reaparición de síntomas, en el resto no tuvo repercusión clínica negativa. Conclusiones: La revisión de tratamientos con una metodología estandarizada y elaborada por el equipo multidisciplinar permite la reducción de PPI en el paciente anciano. Las intervenciones realizadas no tuvieron repercusión clínica negativa en la mayor parte de los residentes

Introduction: Elderly patients are more susceptible to drugs negative effects produced by: interactions, adverse reactions and potentially inappropriate prescriptions (PPI) medication. Objective: To analyze the influence of a standardized treatments reporting system on the number of PPI and drugs that are part of the chronic treatment system. Clinical outcomes were analyzed. Method: It was carried out a prospective, three-month study in which treatments of two nursing homes were reviewed. A first review was made taking the appropriate pharmacotherapeutic decisions. A month after, in a second review, we analyzed whether the decisions had had a negative impact on residents health. Variables analyzed: number of drugs and number of PPI per resident at the beginning and at the end of the study, type of PPI and clinical outcome (no negative impact, withdrawal syndrome, and recurrence of symptoms). Results: 332 treatments were reviewed, 380 PPI were identified. The average number of PPI per resident was significantly reduced from 1.14 to 0.52 (mean difference, -0.63 95%CI [-0.49, -0.76]). The average number of drugs per resident was reduced from 8.76 to 8.32 (mean difference; -0.44 95% CI [0.17, -1.05]), this difference was not statistically significant. In three residents the withdrawal of the drug resulted in recurrence of symptoms, the rest had no negative clinical impact. Conclusions: The review of treatments based on standardized methodology agreed by the multidisciplinary team allows the reduction of PPI in the elderly patient. Interventions had no negative clinical impact in most of the residents

PARP inhibition attenuates histopathological lesion in ischemia/reperfusion renal mouse model after cold prolonged ischemia.

We test the hypothesis that PARP inhibition can decrease acute tubular necrosis (ATN) and other renal lesions related to prolonged cold ischemia/reperfusion (IR) in kidneys preserved at 4°C in University of Wisconsin (UW) solution. Material and Methods. We used 30 male Parp1(+/+) wild-type and 15 male Parp1(0/0) knockout C57BL/6 mice. Fifteen of these wild-type mice were pretreated with 3,4-dihydro-5-[4-(1-piperidinyl)butoxyl]-1(2H)-isoquinolinone (DPQ) at a concentration of 15 mg/kg body weight, used as PARP inhibitor. Subgroups of mice were established (A: IR 45 min/6 h; B: IR + 48 h in UW solution; and C: IR + 48 h in UW solution plus DPQ). We processed samples for morphological, immunohistochemical, ultrastructural, and western-blotting studies. Results. Prolonged cold ischemia time in UW solution increased PARP-1 expression and kidney injury. Preconditioning with PARP inhibitor DPQ plus DPQ supplementation in UW solution decreased PARP-1 nuclear expression in renal tubules and renal damage. Parp1(0/0) knockout mice were more resistant to IR-induced renal lesion. In conclusion, PARP inhibition attenuates ATN and other IR-related renal lesions in mouse kidneys under prolonged cold storage in UW solution. If confirmed, these data suggest that pharmacological manipulation of PARP activity may have salutary effects in cold-stored organs at transplantation.

Partial baroreceptor dysfunction and low plasma nitric oxide bioavailability as determinants of salt-sensitive hypertension: a reverse translational rat study.

This study determined whether clinical salt-sensitive hypertension (cSSHT) results from the interaction between partial arterial baroreceptor impairment and a high-sodium (HNa) diet. In three series (S-I, S-II, S-III), mean arterial pressure (MAP) of conscious male Wistar ChR003 rats was measured once before (pdMAP) and twice after either sham (SHM) or bilateral aortic denervation (AD), following 7 days on a low-sodium (LNa) diet (LNaMAP) and then 21 days on a HNa diet (HNaMAP). The roles of plasma nitric oxide bioavailability (pNOB), renal medullary superoxide anion production (RMSAP), and mRNA expression of NAD(P)H oxidase and superoxide dismutase were also assessed. In SHM (n=11) and AD (n=15) groups of S-I, LNaMAP-pdMAP was 10.5±2.1 vs 23±2.1 mmHg (P<0.001), and the salt-sensitivity index (SSi; HNaMAP-LNaMAP) was 6.0±1.9 vs 12.7±1.9 mmHg (P=0.03), respectively. In the SHM group, all rats were normotensive, and 36% were salt sensitive (SSi≥10 mmHg), whereas in the AD group ∼50% showed cSSHT. A 45% reduction in pNOB (P≤0.004) was observed in both groups in dietary transit. RMSAP increased in the AD group on both diets but more so on the HNa diet (S-II, P<0.03) than on the LNa diet (S-III, P<0.04). MAP modeling in rats without a renal hypertensive genotype indicated that the AD*HNa diet interaction (P=0.008) increases the likelihood of developing cSSHT. Translationally, these findings help to explain why subjects with clinical salt-sensitive normotension may transition to cSSHT.

Partial baroreceptor dysfunction and low plasma nitric oxide bioavailability as determinants of salt-sensitive hypertension: a reverse translational rat study

This study determined whether clinical salt-sensitive hypertension (cSSHT) results from the interaction between partial arterial baroreceptor impairment and a high-sodium (HNa) diet. In three series (S-I, S-II, S-III), mean arterial pressure (MAP) of conscious male Wistar ChR003 rats was measured once before (pdMAP) and twice after either sham (SHM) or bilateral aortic denervation (AD), following 7 days on a low-sodium (LNa) diet (LNaMAP) and then 21 days on a HNa diet (HNaMAP). The roles of plasma nitric oxide bioavailability (pNOB), renal medullary superoxide anion production (RMSAP), and mRNA expression of NAD(P)H oxidase and superoxide dismutase were also assessed. In SHM (n=11) and AD (n=15) groups of S-I, LNaMAP-pdMAP was 10.5±2.1 vs 23±2.1 mmHg (P<0.001), and the salt-sensitivity index (SSi; HNaMAP−LNaMAP) was 6.0±1.9 vs 12.7±1.9 mmHg (P=0.03), respectively. In the SHM group, all rats were normotensive, and 36% were salt sensitive (SSi≥10 mmHg), whereas in the AD group ∼50% showed cSSHT. A 45% reduction in pNOB (P≤0.004) was observed in both groups in dietary transit. RMSAP increased in the AD group on both diets but more so on the HNa diet (S-II, P<0.03) than on the LNa diet (S-III, P<0.04). MAP modeling in rats without a renal hypertensive genotype indicated that the AD*HNa diet interaction (P=0.008) increases the likelihood of developing cSSHT. Translationally, these findings help to explain why subjects with clinical salt-sensitive normotension may transition to cSSHT.

Closed-loop control of renal perfusion pressure in physiological experiments.

This paper presents the design, experimental modeling, and control of a pump-driven renal perfusion pressure (RPP)-regulatory system to implement precise and relatively fast RPP regulation in rats. The mechatronic system is a simple, low-cost, and reliable device to automate the RPP regulation process based on flow-mediated occlusion. Hence, the regulated signal is the RPP measured in the left femoral artery of the rat, and the manipulated variable is the voltage applied to a dc motor that controls the occlusion of the aorta. The control system is implemented in a PC through the LabView software, and a data acquisition board NI USB-6210. A simple first-order linear system is proposed to approximate the dynamics in the experiment. The parameters of the model are chosen to minimize the error between the predicted and experimental output averaged from eight input/output datasets at different RPP operating conditions. A closed-loop servocontrol system based on a pole-placement PD controller plus dead-zone compensation was proposed for this purpose. First, the feedback structure was validated in simulation by considering parameter uncertainty, and constant and time-varying references. Several experimental tests were also conducted to validate in real time the closed-loop performance for stepwise and fast switching references, and the results show the effectiveness of the proposed automatic system to regulate the RPP in the rat, in a precise, accurate (mean error less than 2 mmHg) and relatively fast mode (10-15 s of response time).

E2F4 plays a key role in Burkitt lymphoma tumorigenesis.

Sporadic Burkitt lymphoma (sBL) is a rapidly growing B-cell non-Hodgkin's lymphoma whose treatment requires highly aggressive therapies that often result severely toxic. Identification of proteins whose expression or function is deregulated in sBL and play a role in its formation could facilitate development of less toxic therapies. We have previously shown that E2F1 expression is deregulated in sBL. We have now investigated the mechanisms underlying E2F1 deregulation and found that the E2F sites in its promoter fail to repress its transcriptional activity in BL cells and that the transcriptional repressor E2F4 barely interacts with these sites. We also have found that E2F4 protein levels, but not those of its mRNA, are reduced in sBL cell lines relative to immortal B-cell lines. E2F4 protein expression is also decreased in 24 of 26 sBL tumor samples from patients compared with control tissues. Our data demonstrate that enforced E2F4 expression in BL cells not only diminishes E2F1 levels, but also reduces selectively the tumorigenic properties and proliferation of BL cells, while increasing their accumulation in G(2)/M. Our results therefore point to E2F4 as a target for developing novel and less toxic treatments for sBL.

An improved strategy for evaluating the extent of chronic arterial baroreceptor denervation in conscious rats

There is no index or criterion of aortic barodenervation, nor can we differentiate among rats that have suffered chronic sham, aortic or sino-aortic denervation. The objective of this study was to develop a procedure to generate at least one quantitative, reproducible and validated index that precisely evaluates the extent of chronic arterial barodenervation performed in conscious rats. Data from 79 conscious male Wistar rats of about 65-70 days of age with diverse extents of chronic arterial barodenervation and used in previous experiments were reanalyzed. The mean arterial pressure (MAP) and the heart rate (HR) of all rats were measured systematically before (over 1 h) and after three consecutive iv bolus injections of phenylephrine (PHE) and sodium nitroprusside (SNP). Four expressions of the effectiveness of barodenervation (MAP lability, PHE ratio, SNP ratio, and SNP-PHE slope) were assessed with linear fixed models, three-level average variance, average separation among levels, outlier box plot analysis, and overlapping graphic analysis. The analysis indicated that a) neither MAP lability nor SNP-PHE slope was affected by the level of chronic sodium intake; b) even though the Box-Cox transformations of both MAP lability [transformed lability index (TLI)] and SNP-PHE slope [transformed general sensitivity index (TGSI), {((3-(ΔHRSNP-ΔHRPHE/ΔMAPSNP-ΔMAPPHE))-0.4-1)/-0.04597}] could be two promising indexes, TGSI proved to be the best index; c) TLI and TGSI were not freely interchangeable indexes for this purpose. TGSI ranges that permit differentiation between sham (10.09 to 11.46), aortic (8.40 to 9.94) and sino-aortic (7.68 to 8.24) barodenervated conscious rats were defined.

An improved strategy for evaluating the extent of chronic arterial baroreceptor denervation in conscious rats.

There is no index or criterion of aortic barodenervation, nor can we differentiate among rats that have suffered chronic sham, aortic or sino-aortic denervation. The objective of this study was to develop a procedure to generate at least one quantitative, reproducible and validated index that precisely evaluates the extent of chronic arterial barodenervation performed in conscious rats. Data from 79 conscious male Wistar rats of about 65-70 days of age with diverse extents of chronic arterial barodenervation and used in previous experiments were reanalyzed. The mean arterial pressure (MAP) and the heart rate (HR) of all rats were measured systematically before (over 1 h) and after three consecutive iv bolus injections of phenylephrine (PHE) and sodium nitroprusside (SNP). Four expressions of the effectiveness of barodenervation (MAP lability, PHE ratio, SNP ratio, and SNP-PHE slope) were assessed with linear fixed models, three-level average variance, average separation among levels, outlier box plot analysis, and overlapping graphic analysis. The analysis indicated that a) neither MAP lability nor SNP-PHE slope was affected by the level of chronic sodium intake; b) even though the Box-Cox transformations of both MAP lability [transformed lability index (TLI)] and SNP-PHE slope [transformed general sensitivity index (TGSI), {((3-(ΔHR(SNP)-ΔHR(PHE)/ΔMAP(SNP)-ΔMAP(PHE)))(-0.4)-1)/-0.04597}] could be two promising indexes, TGSI proved to be the best index; c) TLI and TGSI were not freely interchangeable indexes for this purpose. TGSI ranges that permit differentiation between sham (10.09 to 11.46), aortic (8.40 to 9.94) and sino-aortic (7.68 to 8.24) barodenervated conscious rats were defined.

Novedades normativas en materia de incapacidad temporal / New regulations regarding temporary disability

En este artículo ofrecemos una revisión de los cambios normativos más recientes que afectan al sistema español de la Seguridad Social en materia de protección en incapacidades laborales (especialmente Incapacidad Temporal), pues es importante que los médicos generales conozcan cómo estos cambios pueden influir en su actividad profesional diaria (AU)

In this article we offer a review of the most recent regulatory changes affecting the Spanish Social Security System regarding working disability protection (especially Temporary Disability). The general practitioners must know how these changes can influence their diary professional activity (AU)

Efficacy of nitroglycerine infusion versus sublingual nifedipine in severe pre-eclampsia: a randomized, triple-blind, controlled trial.

1. Information regarding the use of continuous i.v. administration of nitroglycerine as an antihypertensive agent in the management of pre-eclampsia is scarce. In the present study, i.v. nitroglycerine or sublingual nifedipine were administered to 32 women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO(4) loading and maintenance doses. Maternal blood pressure and heart rate responses, fetal heart rate responses and perinatal fetal-maternal adverse effects were evaluated using classical parametric and non-parametric data analysis and data modelling by mixed models. 2. An important hypotensive response was observed in both groups, although this reponse was greater, faster and exhibited less variability (more precision) in the nitroglycerine-treated group. Heart rate also increased in both the nitroglycerine- and nifedipine-treated groups (4.6 +/- 4.4 vs 8.6 +/- 5.3 b.p.m., respectively), although the increase in the nifedipine-treated group was almost twofold that in the nitroglycerine-treated group. There were no significant changes in fetal heart rate in response to vasodilator therapy. The frequency of perinatal fetal-maternal adverse effects was similar in both groups at 40% and the adverse effects observed included flushing, headache, palpitations and nausea. 3. In conclusion, i.v. infusion of nitroglycerine is an effective, safe and alternative therapy for severe pre-eclampsia.

[Insulin glargine in intensively-treated type 1 diabetes mellitus]. / Insulina glargina en diabetes mellitus tipo 1 en tratamiento intensivo.

OBJECTIVES: To evaluate the use of insulin glargine in intensively-treated children and adolescents. To assess the degree of patient and parent satisfaction with this treatment. PATIENTS AND METHODS: We studied 42 patients with type 1 diabetes. There were 27 girls and 15 boys. The mean age at diagnosis was 6.8 years (range 1.2-13.2), the mean age at initiation of glargine therapy was 12.8 years (range 7.0-17.7), and the mean duration of diabetes was 6.1 years (range 2.0-11.9). Glargine indications were poor metabolic control or frequent hypoglycemia with multiple daily injections of NPH insulin, which were substituted by one dose of glargine. Patient and parent satisfaction with diabetes treatment was assessed with the scale published by Boot. ANOVA, Student's t test, Mann-Whitney and Fisher tests were applied. RESULTS: Variables are reported as mean 6 standard deviation. After 18 months, glargine reduced hemoglobin A1c levels (7.65 % +/- 0.74 vs. 8.03 % +/- 0.69; p = 0.001), with no significant changes in insulin dose (1.03 +/- 0.19 U/kg/day vs. 1.08 +/- 0.21; p = 0.052) or body mass index SDS (standard deviation score) (+0.51 +/- 0.96 vs. 10.61 +/- 1.02; p = 0.11). Glargine also increased patient satisfaction (+44.5 +/- 18.8 points vs. -9.9 +/- 26.8; p < 0.001) and parent satisfaction (+42.0 +/- 17.9 points vs. -20.8 +/- 29.1; p < 0.001) with diabetes treatment. CONCLUSIONS: 1. Glargine insulin improves metabolic control in intensively-treated children and adolescents with type 1 diabetes. 2. Glargine also improves patient and parent satisfaction with diabetes treatment.

Insulina glargina en diabetes mellitus tipo 1 en tratamiento intensivo / Insulin glargine in intensively-treated type 1 diabetes

Objetivos Evaluar el tratamiento con una pauta insulínica con análogo glargina en niños y adolescentes y valorar el grado de satisfacción de los pacientes y sus padres con esta nueva pauta. Pacientes y métodos Estudio prospectivo de 18 meses de duración con 42 pacientes con diabetes mellitus tipo 1, 27 mujeres y 15 varones, con edad media al inicio de 6,8 años (rango: 1,2-13,2), edad media al inicio del tratamiento con glargina 12,8 años (rango: 7,0-17,7), tiempo de evolución medio 6,1 años (rango: 2,0-11,9). Las indicaciones de la nueva pauta fueron mal control metabólico o hipoglucemias frecuentes con la pauta intensiva con 3 dosis de insulina de acción intermedia (NPH), que fueron sustituidas por una dosis de glargina. El nivel de hemoglobina A1c (HbA1c), la dosis diaria de insulina, el índice de masa corporal (IMC) y la satisfacción de pacientes y padres con el tratamiento de la diabetes se valoraron. Pruebas ANOVA (análisis de la varianza), t de Student, Mann-Whitney y Fisher. Resultados Tras 18 meses de tratamiento con la nueva pauta, se observó una disminución del nivel de HbA1c (7,65 6 0,74 % frente a 8,03 6 0,69 %; p 5 0,001), sin cambios significativos en la dosis de insulina (1,03 6 0,19 U/kg/día frente a 1,08 6 0,21 U/kg/día; p 5 0,052) ni en la EDE (escala de desviación estándar) del IMC (10,51 6 0,96 frente a 10,61 6 1,02; p 5 0,11), mientras que aumentó el grado de satisfacción con el tratamiento de los niños (144,5 6 18,8 puntos en la escala frente a ­9,9 6 26,8; p < 0,001) y de sus padres (142,0 6 17,9 puntos en la escala frente a ­20,8 6 29,1; p < 0,001). Conclusiones 1. La pauta insulínica con glargina mejora el control metabólico en niños y adolescentes con diabetes mellitus tipo 1 en tratamiento intensivo. 2. También mejora el grado de satisfacción de pacientes y padres con el tratamiento de la diabetes

Objectives To evaluate the use of insulin glargine in intensively-treated children and adolescents. To assess the degree of patient and parent satisfaction with this treatment. Patients and methods We studied 42 patients with type 1 diabetes. There were 27 girls and 15 boys. The mean age at diagnosis was 6.8 years (range 1.2-13.2), the mean age at initiation of glargine therapy was 12.8 years (range 7.0-17.7), and the mean duration of diabetes was 6.1 years (range 2.0-11.9). Glargine indications were poor metabolic control or frequent hypoglycemia with multiple daily injections of NPH insulin, which were substituted by one dose of glargine. Patient and parent satisfaction with diabetes treatment was assessed with the scale published by Boot. ANOVA, Student's t test, Mann-Whitney and Fisher tests were applied. Results Variables are reported as mean 6 standard deviation. After 18 months, glargine reduced hemoglobin A1c levels (7.65 % 6 0.74 vs. 8.03 % 6 0.69; p 5 0.001), with no significant changes in insulin dose (1.03 6 0.19 U/kg/day vs. 1.08 6 0.21; p 5 0.052) or body mass index SDS (standard deviation score) (10.51 6 0.96 vs. 10.61 6 1.02; p 5 0.11). Glargine also increased patient satisfaction (144.5 6 18.8 points vs. ­9.9 6 26.8; p < 0.001) and parent satisfaction (142.0 6 17.9 points vs. ­20.8 6 29.1; p < 0.001) with diabetes treatment. Conclusions 1. Glargine insulin improves metabolic control in intensively-treated children and adolescents with type 1 diabetes. 2. Glargine also improves patient and parent satisfaction with diabetes treatment

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]. / Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autnoma de Galicia.

BACKGROUND: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000. METHODS: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model. RESULTS: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). CONCLUSIONS: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in the northwest of spain: analysis of the activity in the region of Galicia

Introducción: España encabeza la actividad trasplantadora internacional y Galiciase sitúa en un nivel semejante; sin embargo, la ausencia de registros oficialesimpide tener conocimiento de los resultados en esta Comunidad Autónoma.Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinarsus resultados en cuanto a supervivencia y factores de riesgo.Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizadosen Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos ypacientes en función de distintas variables relacionadas con receptor y donante.Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan-Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales deCox.Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver,siendo la supervivencia del injerto del 80% y 67% después de uno y cincoaños; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidasde injerto se producen en los primeros doce meses, siendo la causa más frecuentela trombosis vascular (44%). Los factores de riesgo independientes para la pérdidadel injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalode confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05-2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre enrelación a los menores de 40); injerto generado en hospital no trasplantador (RR= 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante(RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte(38%), seguidas de patologías cardiovasculares (30%) y tumores (11%).Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales,es de 50 por millón de población y la supervivencia del paciente es comparablea la de cualquier registro internacional; sin embargo, la supervivencia delinjerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamentemejorable

Background: Spain is the world leader in organ transplant rates, and the nationalaverage is maintained in the northwestern Spanish region of Galicia. However,there is no official registry recording transplantation results in this region. In thispaper we report a study of patient and graft survival and risk factors among kidneytransplant patients in Galicia between january 1996 and december 2000.Methods: Patients receiving kidney transplants in Galicia in the above periodwere monitored up to the end of 2001, deaths and graft losses were recordedand analysed by actuarial and Kaplan-Meier methods, and possible risk factors fordeath and graft loss were evaluated using Cox’s proportional hazards model.Results: In the study period, 672 kidneys were transplanted, all from deceaseddonors. Graft and patient survival rates were respectively 80% and 94% after1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred withinthe first year and the most common cause was vascular thrombosis (44%).Independent risk factors for graft loss were donor asystole (relative risk [RR] =3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR= 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation(RR = 1.56, CI: 1.03-2.37). The main causes of death were infections(38%), followed by cardiovascular pathologies (30%) and tumours (11%).Conclusions: The kidney transplant rate varies excessively within Galicia; the globalrate is 50 per million inhabitants per year. Patient survival is similar to thoserecorded in national registers, but graft survival is deficient, apparently due to ahigh incidence of vascular thrombosis

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in northwestern Spain

Introducción: España encabeza la actividad trasplantadora internacional y Galicia se sitúa en un nivel semejante; sin embargo, la ausencia de registros oficiales impide tener conocimiento de los resultados en esta Comunidad Autónoma. Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinar sus resultados en cuanto a supervivencia y factores de riesgo. Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizados en Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos y pacientes en función de distintas variables relacionadas con receptor y donante. Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan- Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales de Cox. Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver, siendo la supervivencia del injerto del 80% y 67% después de uno y cinco años; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidas de injerto se producen en los primeros doce meses, siendo la causa más frecuente la trombosis vascular (44%). Los factores de riesgo independientes para la pérdida del injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalo de confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05- 2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre en relación a los menores de 40); injerto generado en hospital no trasplantador (RR = 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante (RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte (38%), seguidas de patologías cardiovasculares (30%) y tumores (11%). Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales, es de 50 por millón de población y la supervivencia del paciente es comparable a la de cualquier registro internacional; sin embargo, la supervivencia del injerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamente mejorable

Background: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between january 1996 and december 2000. Methods: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox’s proportional hazards model. Results: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05- 2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under- 40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). Conclusions: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis