Toxicidad pulmonar asociada al empleo de oxígeno hiperbárico: procedimientos de cálculo / Pulmonary toxicity is associated with the hyperbaric oxygen: methods of calculation

OBJETIVOS: Estudiar si una exposición hiperbárica de larga duración motivada por la aparición de una enfermedad descompresiva bajo presión, presenta alteraciones espirométricas y si éstas están acompañadas de sintomatología clínica pulmonar compatible con toxicidad pulmonar por oxígeno. PACIENTES Y MÉTODO: 3 buceadores profesionales que durante una inmersión a 100 metros de profundidad, uno de ellos presenta, antes de terminar la inmersión una patología descompresiva que requiere aumentar los tiempos de respiración de oxígeno, se realizan espirometrías pre- y post-inmersión midiendo: FVC, FEV1, PEF, FEV1/FVC, FEF25-75, FEF 75-85, FEF 25, FEF 50, FEF 75. RESULTADOS: Los resultados post-inmersión demuestran un descenso global de todos los parámetros estudiados destacando el descenso de PEF (12.8%), FEF 50 (9,3%) y FEV1 (8.8%), de forma individual 2 buceadores mostraron descenso de todos los parámetros mientras que un buceador de los nueve parámetros estudiados solo experimentó descenso en cinco. Estos resultados no estuvieron acompañados de sintomatología pulmonar y carecieron de significado estadístico. CONCLUSIONES: Tras esta exposición hiperbárica se alteró el flujo y la capacidad sin la presencia de sintomatología clínica pulmonar y papel importante de la susceptibilidad individual. Los estudios de función pulmonar se deberían extender a colectivos sometidos a: cambios constantes de presión y a la respiración de oxígeno, gas con efectos tóxicos agudos y a largo plazo (AU)

INTRODUCTION: We studied if one hyperbaric exposition in the long term with decompression sickness under pressure causes disturbances in the pulmonary functions and if they are related with clinical manifestations which are compatibles with pulmonary oxygen toxicity. PATIENTS AND METHOD.-Three professional divers carried out one immersion at 100 meters of deep, only one person displayed, before the immersion was finished, one decompression pathology which need increase the times breathing of oxygen, we valued the pulmonary functions pre and post immersion so we measured: FVC, FEV1, PEF, FEV1/FVC, FEF25-75, FEF 75-85, FEF 25, FEF 50 and FEF 75. RESULTS: The post immersion results showed one total decline of all studied parameters showed the decrease of PEF (12.8%), FEF 50 (9.3%) and FEV1 (8.8%), two divers showed one decline of all parameters meanwhile that one diver registered decrease only in five parameters. These results are not accompanied of pulmonary symptoms and of significant statistic. CONCLUSIONS: After this hyperbaric exposure, the flow and the capacity were disturbed but they did not show neither clinic pulmonary symptoms nor had one important role in the personal susceptibility. The studies of pulmonary function should include group with constant pressure changes and the breathing of oxygen, this gas have acute toxic effects in the long term (AU)

[Tuberculosis in the area of Lorca: to adapt or resist]. / Tuberculosis en la comarca de Lorca: adaptarse o resistir.

OBJECTIVE: We studied the epidemiological characteristic of tuberculosis in Lorca area, drug resistant and the effect of the immigration population (Ecuador) in this area. PATIENTS AND METHODS: A retrospective study for six years ago (1999, January to 2004, December) was realized. Epidemiological data, initial diagnostic probability, mycobacteria stain and cultive, drug resistance, treatment response, and epidemiological differences between immigrants and spain population were compared. RESULTS: Within 158 cases registered, 41.7 percent were immigrants with less than one year in Spain, the most part Ecuador population. We observed that extrapulmonar tuberculosis was lower initial diagnostic probability than pleural disease as well too haemoptisis, pleural pain and weight loss. It was identified positive micobacterial stain in 35.4 percent of respiratory samples. It was successfully results in 74 percent of cases and 13.9 percent of patients were lost, this result was frequently registered in immigrants, The isoniazide resistant in patients with not previous treatment was 5.3 percent and it was 9.5 percent in immigrants and 10.8 percent in Ecuador population. CONCLUSION: It is necessary improve: the diagnostic of extrapulmonar tuberculosis and avoid loss patient by programs of capture and then the successfully treatments raise. The isoniazide resistant in this area suggest that we must use initial four drug than tree and this manner not raise the drug resistant in the area.

Morphogenesis of rat experimental pulmonary emphysema induced by intratracheally administered papain: changes in elastic fibres.

The ultrastructural changes of elastic fibres in emphysematous lungs have been studied in men, but few works exist on this topic in experimental emphysematous animals. In this paper, the morphogenesis of emphysema and alterations of the elastic fibres produced by the instillation of papain are described by light and electron microscopy. Wistar rats were instilled through the trachea with papain at a rate of 3 mg/100 g animal weight. The animals were sacrificed 12 h, 3 days, 10 days and 60 days after enzyme instillation. The "Mean Linear Intercept" (MLI), the "Number of fenestrations/respiratory units" (NF) the "Number of macrophages per mm of alveolar wall" (NM) and the "Number of respiratory unit/mm2" (RU), both in the control and experimental groups were studied. Two months after treatment, the experimental group showed a strong increase in the MLI (p<0.001) and NF (p<0.001), and a diminished number of RU (p<0.05) compared with the control group. Partial correlation analysis showed a positive correlation only between MLI and NF. Twelve hours after papain instillation an inflammatory response was observed, the elastic fibres were ruptured, while the microfibrilar component remained. New formations of eulanin elastic fibres were observed three days post papain instillation. After ten days the interalveolar oedema had disappeared and the elastic fibres were of normal morphology although irregular groups of strips of elastic fibres were evident. A mixed pattern of panlobular, centrilobular and normal lung zones were observed. Two months after papain instillation abundant accumulations of elastic fibres of irregular outline were observed associated to collagen fibres. In conclusion, the morphometric parameters studied showed a significant progression of the emphysema. The strong correlation between NF and MLI suggested that papain-induced emphysema is principally caused by breaches of the alveolar walls. The results seem to point to a very abnormal remodelling process associated with elastic fibre regeneration, although there were no signs of destruction of these new fibres formed in emphysematous rat lung induced by papain.

Tuberculosis en la comarca de Lorca: adaptarse o resistir / Tuberculosis in the area of Lorca: to adapt or resist

Objetivo: analizar las características epidemiológicas de los casos de tuberculosis del área de salud de la comarca de Lorca, su resistencia a fármacos y el impacto de la población inmigrante mayoritaria (Ecuador) en la misma. Pacientes y métodos: estudio longitudinal, retrospectivo de 6 años de duración (de enero de 1999 a diciembre 2004). Se recogieron datos epidemiológicos de cada caso, probabilidad diagnóstica inicial, tinciones diagnósticas, aislamientos, resistencia a fármacos, respuesta al tratamiento, así como, las diferencias epidemiológicas existentes entre inmigrantes y autóctonos. Resultados: Se identificaron 158 casos, 41,7% eran inmigrantes con menos de 1 año de estancia en nuestro país, mayoritariamente procedentes de Ecuador. Observamos que la tuberculosis extrapulmonar para el clínico tenía una probabilidad diagnóstica baja, mientras que la pleural era alta, junto a síntomas como hemoptisis, dolor pleurítico y constitucionales. En 35,4% de los casos se idéntifico germen por tinción en muestras respiratorias. Se obtuvo un 74% de resultados satisfactorios por el tratamiento y 13,9% de abandono asociado frecuentemente con la inmigración. La resistencia a isoniazida en no tratados fue del 5,3% en el área, 9,5% en el caso de inmigrantes y 10,8% en los oriúndos de Ecuador. Conclusión: Se debe mejorar en: la detección de los casos extrapulmonares, evitar el abandono con la captación de los enfermos y la curación de enfermedad. Las resistencias a isoniazida en nuestra área sugiere adaptarse a tratamientos de inicio con cuatro fármacos y no a tres para evitar incremento de resistencias en nuestra área de salud

Objective: We studied the epidemiological characteristic of tuberculosis in Lorca area, drug resistant and the effect of the immigration population (Ecuador) in this area. Patients and methods: A retrospective study for six years ago (1999, January to 2004, December) was realized. Epidemiological data, initial diagnostic probability, mycobacteria stain and cultive, drug resistance, treatment response, and epidemiological differences between immigrants and spain population were compared. Results: Within 158 cases registred, 41.7 percent were immigrants with less than one year in Spain, the most part Ecuador population. We observed that extrapulmonar tuberculosis was lower initial diagnostic probability than pleural disease as well too haemoptisis, pleural pain and weight loss. It was identified positive micobacterial stain in 35.4 percent of respiratory samples. It was succesfully results in 74 percent of cases and 13.9 percent of patients were lost, this result was frecuently registred in immigrants, The isoniazide resistant in patients with not previous treatment was 5.3 percent and it was 9.5 percent in immigrants and 10.8 percent in Ecuador population. Conclusion: It is necessary improve: the diagnostic of extrapulmonar tuberculosis and avoid loss patient by programs of capture and then the succesfully treatments raise. The isoniazide resistant in this area suggest that we must use initial four drug than tree and this manner not raise the drug resistant in the area

Influence of residency training on personal stress and impairment in family life: analysis of related factors.

OBJECTIVES: This cross-sectional study was designed to assess the level of stress among residents and stress-related impairment of family life. SUBJECTS AND METHODS: A 41-item anonymous questionnaire was designed to determine the level of stress and its effects on the residents' family as well as factors associated with stress during residency training in a tertiary-care hospital accredited with official resident training 'Medicos Internos Residentes' in Murcia, Spain. Questionnaires were distributed in sealed nominal envelopes during February and March 2002 to 227 eligible residents. RESULTS: Of the 227 residents, 175 (77%) completed and returned the questionnaires. Forty-two percent of residents recognized that residency training caused an important level of stress and 21% felt that stress interfered with family relationships. Both factors were significantly associated. Feelings of being unsatisfied with supervision of care and achievement of training objectives as well as low satisfaction with residency training and poor assessment of the hospital were significant stressors. Impairment in family life was significantly dependent on degree of satisfaction with residency training and evaluation of the hospital. CONCLUSION: The data showed that residency training generated stress and impaired family life. These were closely associated with perception of being unsatisfied with the residency training and evaluation.

Respuesta pulmonar ante una exposición hiperóxica controla. Valoración de 4 buceadores militares / Pulmonary response to a controlled hyperroxidic exposure

El oxígeno a presiones superiores a la atmosférica se emplea en la oxigenoterapia hiperbárica (OHC), buceo en saturación tratamiento de las patologías disbáricas. La OHB expone al sujeto a los efectos tóxicos de los radicales libres que pueden afectar la función pulmonar. Las tablas de tratamiento de accidentes de buceo presentan valores UPTD dentro de rangos no tóxicos, lo que no implica una afectación pulmonar. Realizamos a 4 buceadores tratados, al mismo tiempo, con tabla 6 (Uptd=625) estudios de función pulmonar al concluir el tratamiento y 14 horas después. El uso de la tabla 6 para accidentes de buceo produce una afectación pulmonar de carácter asintomático y reversible (AU)

Oxygen, with higher pressures than atmosphere ones, is used in hyperbaric oxygen theraphy (OHB), saturation´s diving and for the treatment of the disbaric pathologies. The subject is exposed by the OHB to the toxic effects of the free radicals, which can effect the pulmonary function. The tables of treatments for diving accidents present UPTD values within no toxic ranges, an it does not implies a pulmonary damage. We have done to 4 divers treated, at the same time, using table 6 (UPTD=625) studies of pulmonary function at the end of treatment and 14 hours later. After treatment values: FVC% (104,75 ±7.9), FEV1% (91,25±10,81), FEV1/FVC% (74±3.55), FEF 25-75% (70.5±12.23) FEF, 75-85% (69.5±15.5). Values of 14 hours later. FVC% (109.25±8.09), FEV1% (96,75±11.84), FEV1/FVC (74.75±3.77), FEF 25-75% (76±14.16), FEF 75-85% (76.5 ± 15.84). The use of table 6 for diving accidents produces an asymptomatic and reversible pulmonary affection (AU)

Hemoptisis: revisión de 70 casos / Hemoptysis: a review of 70 cases

Objetivos: Conocer las características etiológicas de los pacientes ingresados en la sección de Neumología por hemoptisis y su distribución en nuestro medio con relación a otras series. Métodos: Se realizó un estudio retrospectivo revisando las historias clínicas de los pacientes diagnosticados de hemoptisis en el servicio de neumología del Hospital Universitario Virgen de la Arrixaca, durante el año 2002. Resultados: Se estudiaron 70 pacientes, de los cuales 15 (21,4%) eran mujeres, y 55 hombres (78,5%). La edad media fue de 58,7 años. Fumadores y exfumadores de menos de 10 años constituyeron el 48,6%, exfumadores de más de 10 años 17,14%, no fumadores 35,7%. Los diagnósticos obtenidos fueron: bronquiectasias 24,3%, cáncer de pulmón 20%, infecciones respiratorias 12,8%, criptogenéticas 11,4%, bronquitis crónica 8,5%, TBC activa 7,1%, lesiones residuales por TBC 4,3%; abscesos 2,8%; sobredosificación por dicumarínicos 2,8%, malformaciones vasculares 2,8%, aspergiloma 1,4% fibrosis pulmonar 1,4%. Por rangos de edad encontramos diferencias, presentándose como primera causa en pacientes en mayores de 80 años y entre 50-59 años el cáncer de pulmón, entre 60 y 79 años las bronquiectasias y en los menores de 50 las infecciones respiratorias. El cáncer, también supone la primera causa en los pacientes fumadores y exfumadores desde hace menos de 10 años. Entre los exfumadores de más de 10 años destacan las bronquiectasias y en los no fumadores las infecciones respiratorias. En cuanto al diagnóstico la TC es diagnóstica en el 61,1%, la RX tórax en el 44,4% y la broncoscopia en el 11,1%; aunque localiza el sangrado en hasta el 47,2%. Conclusiones: La causa más frecuente de hemoptisis en nuestro medio es la secundaria a bronquiectasias, seguidas del cáncer de pulmón y de las infecciones respiratorias (AU)

Objectives: The aim of this review is know the etiology of hemoptysis in pneumology´s patients and its distribution in ours area compared with others series. Methods: We have made a restrospective and descriptive study about the clinical records of patients with diagnosis of hemoptysis in pneumology section from our hospital during the year 2002. Results: We have studied 70 clinical reports: 15 (21.4%) were women and 55 men (78.5%). The mean age was 58.7 years. Smoker and ex-smoker of less than 10 years were 48.6%, ex-smoker of more than10 years were 17.14% and non-smoker were 35.7%. The result included the following diagnosis: bronchiectasis 24.3%, lung cancer 20%, respiratory infecctions 12.8%, criptogenic 11.4%, chronic bronchitis 8.5%, active TBC 7.1%, residual lesions of TBC 4.3% abscess 2.8%, overdosis of anticoagulants 2.8%, vascular malformation 2.8%, aspergilloma 1.4% pulmonary fibrosis 1.4%. For age intervals we found differences: In the intervals 81-90 years and 51-60 years the main cause were lung cancer, between 61-80 years were bronchyectasis and <50 years respiratory infecitons. The lung cancer were also the most important cause the hemoptysis among the smokers and ex-smokers of less than 10 years. In non-smokers were the bronchiectasis. Conclusion: Bronchiectasis, lung cancer, and respiratory infections are the most common causes of hemoptysis in our area. In the same way that others series, we have found a important descent of impact of tuberculosis, but not in the bronchiectasis, as in others mediterraneans countries, where in their series is the main cause of hemoptysis (AU)

Pomegranate juice supplementation in chronic obstructive pulmonary disease: a 5-week randomized, double-blind, placebo-controlled trial.

OBJECTIVE: The aim of the present study is to investigate the effect of antioxidant polyphenol-rich pomegranate juice (PJ) supplementation for 5 weeks on patients with stable chronic obstructive pulmonary disease (COPD), since the oxidative stress plays a major role in the evolution and pathophysiology of COPD. DESIGN: A randomized, double-blind, placebo-controlled trial was conducted. SUBJECTS: A total of 30 patients with stable COPD were randomly distributed in two groups (15 patients each). INTERVENTIONS: Both groups consumed either 400 ml PJ daily or matched placebo (synthetic orange-flavoured drink) for 5 weeks. Trolox Equivalent Antioxidant Capacity (TEAC) of PJ, blood parameters (14 haematological and 18 serobiochemical), respiratory function variables, bioavailability of PJ polyphenols (plasma and urine) and urinary isoprostane (8-iso-PGF(2alpha)) were evaluated. RESULTS: The daily dose of PJ (containing 2.66 g polyphenols) provided 4 mmol/l TEAC. None of the polyphenols present in PJ were detected in plasma or in urine of volunteers. The most abundant PJ polyphenols, ellagitannins, were metabolized by the colonic microflora of COPD patients to yield two major metabolites in both plasma and urine (dibenzopyranone derivatives) with no TEAC. No differences were found (P > 0.05) between PJ and placebo groups for any of the parameters evaluated (serobiochemical and haematological), urinary 8-iso-PGF(2alpha), respiratory function variables and clinical symptoms of COPD patients. CONCLUSIONS: Our results suggest that PJ supplementation adds no benefit to the current standard therapy in patients with stable COPD. The high TEAC of PJ cannot be extrapolated in vivo probably due to the metabolism of its polyphenols by the colonic microflora. The understanding of the different bioavailability of dietary polyphenols is critical before claiming any antioxidant-related health benefit. SPONSORSHIP: 'Fundación Séneca' (Murcia, Spain), Project PB/18/FS/02 and Spanish CICYT, Project AGL2003-02195.

Cold urticaria associated with acute serologic toxoplasmosis.

Cold urticaria is defined as a urticarial and/or angioedematous reaction of the skin to contact with cold objects, water or air. Types of urticaria associated with infectious diseases, such as mononucleosis, rubeola, varicella, syphilis, hepatitis, and HIV infection have been reported. We present the case of a patient who developed cold urticaria associated with acute serologic toxoplasmosis. The patient was a 34-year-old man who for the previous 2 months had presented cutaneous pruritus accompanied by several papular lesions in parts of the skin exposed to cold as well as those in contact with cold water. The result of an "ice-cube test" was positive. Serologic tests for Toxoplasma gondii showed an IgG level of 68 UI/ml and were positive for IgM, while a test for cryoglobulins was positive. One month later cryoglobulins were negative and a serologic test for T. gondii showed an IgG concentration of 75 UI/ml and positive IgM. Three months later cryoglobulins were still negative, IgG for T. gondii was 84 UI/ml, and IgM was positive. After 6 months cryoglobulins were still negative, IgG level was 68 UI/ml and IgM was still slightly positive. In the final evaluation, 14 months later, IgG level was 32 UI/ml and IgM was negative. The patient continues to present clinical manifestations of cold urticaria, although he has experienced some improvement and his tolerance to cold has increased after treatment with cetirizine.

Importancia del tutor de la especialidad en la satisfacción y formación de los médicos internos residentes / Importance of speciality tutor in the satisfaction and formation of the internal doctors residents

No disponible

No disponible

Cold urticaria associated with acute serologic toxoplasmosis

Cold urticaria is defined as a urticarial and/or angioedematous reaction of the skin to contact with cold objects, water or air. Types of urticaria associated with infectious diseases, such as mononucleosis, rubeola, varicella, syphilis, hepatitis, and HIV infection have been reported. We present the case of a patient who developed cold urticaria associated with acute serologic toxoplasmosis. The patient was a 34-year-old man who for the previous 2 months had presented cutaneous pruritus accompanied by several papular lesions in parts of the skin exposed to cold as well as those in contact with cold water. The result of an "ice-cube test" was positive. Serologic tests for Toxoplasma gondii showed an IgG level of 68 UI/ml and were positive for IgM, while a test for cryoglobulins was positive. One month later cryoglobulins were negative and a serologic test for T. gondii showed an IgG concentration of 75 UI/ml and positive IgM. Three months later cryoglobulins were still negative, IgG for T. gondii was 84 UI/ml, and IgM was positive. After 6 months cryoglobulins were still negative, IgG level was 68 UI/ml and IgM was still slightly positive. In the final evaluation, 14 months later, IgG level was 32 UI/ml and IgM was negative. The patient continues to present clinical manifestations of cold urticaria, although he has experienced some improvement and his tolerance to cold has increased after treatment with cetirizine

La urticaria por frío se define como una reacción en forma de urticaria y/o angioedema de la piel al contacto con objetos, agua o aire fríos. Se han documentado varios tipos asociados a enfermedades infecciosas como mononucleosis, sarampión, varicela, sífilis, hepatitis e infección por VIH. Presentamos el caso de un paciente que desarrolló urticaria por frío asociada a una toxoplasmosis serológica aguda. El paciente era un hombre de 34 años que llevaba dos meses presentando prurito cutáneo acompañado de varias lesiones papulares en zonas de la piel expuestas al frío o en contacto con agua fría. Se le realizó la "prueba del cubito de hielo", con resultado positivo. Los resultados de la pruebas serológicas para la detección de Toxoplasma gondii fueron de 68 UI/ml de IgG e IgM positiva. La prueba de crioglobulinas resultó asimismo positiva. Al cabo de un mes, las crioglobulinas resultaron negativas, y la prueba serológica para la detección de Toxoplasma gondii mostró un nivel de IgG de 75 UI/ml y una IgM positiva. Al cabo de tres meses, las crioglobulinas resultaron también negativas, la IgG frente a Toxoplasma gondii fue de 84 UI/ml y la IgM resultó positiva. Al cabo de seis meses, las crioglobulinas siguieron resultando negativas, el nivel de IgG fue de 68 UI/ml y la IgM siguió ligeramente por encima del nivel positivo. En el último control, al cabo de catorce meses, el nivel de IgG fue 32 UI/ml y la IgM resultó negativa. El paciente ha seguido presentando manifestaciones clínicas de urticaria por frío, si bien ha experimentado una cierta mejoría en la afección, y su tolerancia al frío ha aumentado tras un tratamiento con cetiricina

[Scintigraphic study of gastric emptying of rehydration drinks in athletes]. / Estudio gammagráfico del ritmo de vaciado gástrico de bebidas de reposición en deportistas.

UNLABELLED: This study aims to evaluate how rehydration beverage ingestion influences gastric emptying rate (in cycle ergometer) at rest and during exercise at 70 % of maximal oxygen consumption (VO2max). MATERIAL AND METHOD: 26 well-trained cyclists performed a preliminary maximal test until exhaustion to evaluate their VO2max, and two submaximal exercise tests at 70 % of their mode-specific VO2max. Each test was separated by one week. During the two submaximal tests, cyclists consumed 200 ml of a 99mTc-DTPA labeled rehydration beverage (A or B) and scintigraphy determinations were performed at rest. After, exercise was initiated for 60 minutes with an intake rate of 200 ml every 15 minutes, making gastric serial scintigraphy determinations. The difference regarding chemical composition between A and B drinks resides in the fact that drink A contains a smaller load in carbohydrates (10.3 g/100 ml versus 15.2 g/100 ml of B), proteins in form of serum milk and antioxidants in form of fruit juice. Both contain ions and vitamins. RESULTS: at rest, gastric count number was significantly reduced (p > 0.000) from 0 to 25 minutes for both A and B beverage. At the end of exercise (60 min), there was greater gastric retention for B beverage than for A, this difference being statistically significant (p < 0.031). CONCLUSIONS: The A beverage, a rehydration drink on the market with protein and antioxidants with fruit juice content, has a faster gastric emptying rate than the B sport beverage.

Estudio gammagráfico del ritmo de vaciado gástrico de bebidas de reposición en deportistas / Scintigraphic study of gastric emptying of rehydration drinks in athletes

El propósito de este trabajo es determinar cómo influye la ingesta de bebidas de reposición, tanto en reposo como durante la actividad física (en cicloergómetro), sobre el ritmo de VG a un consumo máximo de oxígeno (VO2máx) del 70 %. Material y método: 26 ciclistas bien entrenados realizaron una prueba de esfuerzo previa hasta el agotamiento para determinar su VO2máx, y dos pruebas de esfuerzo submaximales al 70 % del VO2mx, separando cada prueba por una semana. Durante las dos pruebas submaximales, los ciclistas consumieron 200 ml de bebida de reposición (A o B) marcada con 99mTc-DTPA y se realizaron adquisiciones gammagráficas gástricas en reposo; posteriormente iniciaron el ejercicio durante 60 minutos a un ritmo de ingesta de 200 ml cada 15 minutos con adquisiciones gammagráficas seriadas. La diferencia en cuanto a composición química entre bebida A y bebida B radica en que la bebida A contiene menor carga en carbohidratos (10,3 gr/100 ml, frente a 15,2 gr/100 ml de la B), proteínas en forma de suero de leche y antioxidantes en forma de zumo de frutas; ambas contienen iones y vitaminas. Resultados: durante el reposo, el número de cuentas gástricas disminuyó significativamente desde el minuto 0 al 25, tanto para la bebida A como para la B (p < 0,001). Al final de los 60 minutos de ejercicio se produjo una mayor retención gástrica de bebida B que de A, siendo esta diferencia estadísticamente significativa (p < 0,031). Conclusiones: La bebida A, bebida de reposición en el mercado con contenido proteico y antioxidantes en forma de zumos de frutas, vacía más rápido que la bebida B

This study aims to evaluate how rehydration beverage ingestion influences gastric emptying rate (in cycle ergometer) at rest and during exercise at 70 % of maximal oxygen consumption (VO2max). Material and method: 26 well-trained cyclists performed a preliminary maximal test until exhaustion to evaluate their VO2max, and two submaximal exercise tests at 70 % of their mode-specific VO2max. Each test was separated by one week. During the two submaximal tests, cyclists consumed 200 ml of a 99mTc-DTPA labeled rehydration beverage (A or B) and scintigraphy determinations were performed at rest. After, exercise was initiated for 60 minutes with an intake rate of 200 ml every 15 minutes, making gastric serial scintigraphy determinations. The difference regarding chemical composition between A and B drinks resides in the fact that drink A contains a smaller load in carbohydrates (10.3 g/100 ml versus 15.2 g/100 ml of B), proteins in form of serum milk and antioxidants in form of fruit juice. Both contain ions and vitamins. Results: at rest, gastric count number was significantly reduced (p > 0.000) from 0 to 25 minutes for both A and B beverage. At the end of exercise (60 min), there was greater gastric retention for B beverage than for A, this difference being statistically significant (p 0.000) from 0 to 25 minutes for both A and B beverage. At the end of exercise (60 min), there was greater gastric retention for B beverage than for A, this difference being statistically significant (p < 0.031). Conclusions: The A beverage, a rehydration drink on the market with protein and antioxidants with fruit juice content, has a faster gastric emptying rate than the B sport beverage

Research training during medical residency (MIR). Satisfaction questionnaire.

INTRODUCTION: It is during Medical Residency Training (MIR) that knowledge, abilities and habits are acquired, which will shape professional activity in the future. It is therefore very likely that residents who do not acquire the necessary habits and knowledge for research activities will eventually not carry out these activities in the future. The aim of this study was to analyze the level of satisfaction of residents with his or her scientific and research training, and to determine any deficiencies with respect to this training. MATERIALS AND METHODS: The aim of the questionnaire used was to determine the level of satisfaction of residents regarding their scientific and research training during their residency period. Questionnaires were usually distributed via internal mail to all residents (MIR physicians) registered at a third level teaching hospital, with a completion rate of 78% (n = 178). RESULTS: As far as the evaluation of scientific training is concerned, 68% of residents were dissatisfied or very dissatisfied. With respect to scientific studies carried out, 49% of residents had not taken part in any, but the number of studies carried out increases as the residency progresses. On the other hand, 22% of residents reported not having started their doctoral thesis, 50% having attended doctorate courses, 24% having a title for their thesis, and only 4% having written a thesis. Doctorate courses, thesis topics, and written theses increase with the year of residency, and a greater activity may be seen in this respect in surgical departments. If we analyze help available to residents for their carrying out scientific activities, 55% reported that only selected assistant doctors would offer help, and 21% reported that no doctors would offer help. Dissatisfaction with research training increases with the year of residency. With regard to main specialist fields, it can be seen that residents in surgical fields carry out more theses, whereas central fields report less facilities. Finally, if we evaluate the influence that these variables may have on the general satisfaction of residents with his or her residency, these variables are seen to be significant factors of dissatisfaction. CONCLUSIONS: Most residents are dissatisfied with their scientific training and have relatively few facilities for developing such skills, which in turn results in a scarce number of scientific studies and doctoral theses.

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.

BACKGROUND: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. METHODS: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. RESULTS: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. CONCLUSIONS: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.

[Pharmacoeconomic analysis of patients with acute exacerbation of chronic bronchitis treated with telithromycin or cefuroxime-axetil]. / Análisis farmacoeconómico del tratamiento de pacientes con exacerbación aguda de la bronquitis crónica con telitromicina o cefuroxima-axetilo.

INTRODUCTION: A pharmacoeconomic analysis was done to compare the efficiency of two treatments in the acute exacerbation of chronic bronchitis: telithromycin and cefuroxime-axetil. METHODS: Restrospective analysis, modeled through a decision tree. The effectiveness of the treatments was estimated through a randomized and double-blind clinical trial in which 800 mg/day (5 days) of telithromycin were compared with 1,000 mg/day (10 days) of cefuroxime-axetil in patients with acute exacerbation of chronic bronchitis (140 and 142 patients, respectively). Resources use was estimated from clinical trial and from Spanish data, and the unit costs through a health costs dabatase. The model was validated by a panel of Spanish clinical experts. RESULTS: Since the clinical trial was designed to demonstrate equivalence, there were no significant differences of effectiveness among both treatments (with a rate of clinical cure of 86.4% and 83.1%, respectively) which means that an analysis of costs minimization was done. In the average case, the average cost of the disease by patient was 174.83 Euros with telithromycin and 194.68 Euros with cefuroxime-axetil (a difference of 19.85 Euros). The results were maintained in the analysis of sensitivity, with favorable differences for telithromycin that ranged between 18.04 Euros and 22.25 Euros. CONCLUSIONS: With telithromycin up to 22 Euros by patient with acute exacerbation of chronic bronchitis could be saved, in comparison with cefuroxime-axetil.

Alergia ocupacional por monosensibilización a Tribolium Confusum

Introducción: Como agente causante de asma en el panadero se ha señalado, en general, las proteínas presentes en dicha materia prima, pertenecientes tanto al mismo cereal como a algunos de los insecto que a menudo infestan estas materias vegetales. Caso Clínico: Presentamos un caso de alergia ocupacional causada por Tribotium confusum en una trabajadora de panadería, en donde despachaba pan, que resultó ser monosensible a dicho insecto, y que presentaba síntomas de asma bronquial, rinitis, conjuntivitis y angioedema al contacto con harina contaminada. Diagnosticamos a la paciente de asma mediante la medición del pico de flujo respiratorio y la prueba de broncodilatación. Descartaremos la alergia a otros alérgenos habituales y de la panadería como de alergenos alimentarios. Confirmamos la sensibilización a Tribolium confusum mediante prueba cutánea y de provocación nasal positiva. Los extractos para pruebas in vivo se obtuvieron de la harina que utilizaban en la panadería tras cultivo y estudio entomológico preciso. Diagnóstico definitivo: Rinoconjuntivitis, Asma bronquial, Angioedema de origen ocupacional por sensibilización a Tribolium confusum. Los síntomas son producidos por harina de panificadora infestada con T confusum (Insecta, Coleóptera, Tenebrionidae, Ulominae) que contenía abundantes ejemplares preimaginales y adultos de dicho insecto. Discusión: Ante el estudio de un paciente con asma en la panadería, nos debemos de plantear la existencia de alergia a diferentes alergenos ocultos o, incluso, aún por describir, pese a existir sensibilidad a otros alergenos comunes. como las proteínas de los cereales o las enzimas utilizadas en los procesos de panificación (AU)

The cauative agent in baker's asthma is generally accepted to be the proteins present in tlour, which can be derived from the cereal itself or from some of the insect that frequently infest these vegetable products. We present a case of occupational allergy due to Tribolium confusum sensitisation in a female bakery worker; the patient was monosensitied to that insectand evidenced symptoms of bronchial asthma, rhinitis, conjuntivitis and angiedema upon contact witb contaminated flour. The diagnosis of bronchial asthma was confirmed by ex piratory peak flow measurement and bronchodilator testing, and sensitiation to other comrnon allergen and bakery allergens was ruled out. Sensitisation to Tribolium confusum was confirmed by the positive result of the kin and nasal challenge tests. The extracrs used for the in vivo tests were prepared from the flour the patient used in the bakery. after culture and exhaustive entomological study. The difinitive diagnosis was rhinoconjunctivitis, bronchial asthma and angioedema of occupational origin due to Tribolium confusum sensitisation. The symptoms were induced by bakery flour infested with T confusum (lnsecta. Choleoptera,Tenebrionidae. Ulominae). which contained abundant specimens. both of pre-imagotages and of the adult insect. In the study of a patient with bakers asthma one mu t always consider the possibility of allergic sensitisation to various occult or even as yet undicovered allergens, even when there in confirmed sensitisation to other more common allergen such a cereal proteins or the enzymes used in the baking proces (AU)

[Incidence, air pollution and risk factors of acute otitis media in the first year of life: a prospective study]. / Incidencia, contaminación ambiental y factores de riesgo de otitis media aguda en el primer año de vida: estudio prospectivo.

BACKGROUND: Epidemiological studies of acute otitis media (AOM) are scarce and no prospective studies have been performed in Spain. OBJECTIVES: To describe the incidence of AOM in the first year of life and its associated risk factors, with special focus on air pollution. METHODS: We performed a prospective cohort study of 229 newborn infants during the first year of life stratified by pollution zones, and followed-up by their pediatricians in their health center. AOM was defined on clinical grounds. A questionnaire on risk/protective factors included items on the following: sex, older siblings, smoking, breastfeeding, socioeconomic status, parental education and the mother's occupational status. RESULTS: The incidence of AOM episodes during the first year of life was 45 % and the proportion of children who experienced at least one episode was 32 %. Independent risk factors were male gender (aOR: 2.03; 95 % CI: 1.09-3.7) and living in a polluted area (aOR: 2.01; 95 % CI: 1.05-3.84). Independent protective factors were being born in spring (aOR: 0.41; 95 % CI: 0.19-0.88) and having a mother with at least primary school education (aOR: 0,53; 95 % CI: 0.24-1.15). Socioeconomic markers indicated a lower mean level among families whose children had at least one AOM episode. CONCLUSIONS: Air pollution and low socioeconomic status are greater risk factors for AOM than having siblings or parents who smoke. A minimum educational level reduces the risk of AOM. The incidence of AOM could be reduced by modifying certain environmental factors.