Neumomediastino: una complicación frecuente de neumonía COVID-19 / Pneumomediastinum: a frequent complication of covid-19 pneumonia

Introducción: El neumomediastino es una complicación en pacientes con COVID-19, ocasionado en el contexto de un proceso inflamatorio importante. Metodología: Se realizó un estudio descriptivo, retrospectivo y transversal. Se revisaron las tomografías de tórax e historias clínicas de pacientes con y sin diagnóstico de COVID-19 entre el 1 de abril y el 30 de julio de 2020. Resultados: Se identificaron 66 pacientes con neumomediastino y diagnóstico de COVID-19. La prevalencia encontrada fue de 3,2%, el 81,8% correspondía al sexo masculino, la edad promedio fue 53,4 años, el tiempo de estancia media hospitalaria fue de 22,98 días, las comorbilidades más frecuentes fueron la obesidad, diabetes e hipertensión arterial. El 95,5% no reportó tabaquismo y el 89,4% no estuvo en ventilación mecánica. Los síntomas más frecuentes fueron la disnea, tos no productiva y dolor torácico. El 69,7% de pacientes tuvieron desenlace fatal. En la tomografía pulmonar se evidenció que el 43,9% presentó neumomediastino de grado moderado, y respecto al compromiso pulmonar el 97% presentó un patrón típico bilateral, el estadio evolutivo pico y progresivo se presentó en 56,1% y 31,8% respectivamente y el porcentaje de afectación pulmonar más frecuente fue el grave (53%). Un porcentaje de afectación pulmonar mayor al 50% se correlacionó directamente con la gravedad del neumomediastino (p<0,05). La ferritina promedio fue 884,58 ug/ml, dímero D 5,1 mg/ml, DHL 595,55 UI/L, PCR 150,7 mg/L, linfocitos 825,1 c/mm3, ácido láctico 1,99 mmol/L, PCT 0,78 ng/ml, IL6 313 pg/ml y PaFiO2 171,5 mmHg. Conclusión: El neumomediastino espontáneo es una complicación frecuente en pacientes con COVID-19, siendo un indicador de mala evolución.(AU)

Introduction: Pneumomediastinum is a frequent complication in patients with COVID-19, caused in the context of a major inflammatory process. Methodology: A descriptive, retrospective and cross-sectional study was conducted. We reviewed the chest CT scans and medical records of patients with/without a diagnosis of COVID-19 between April 1 and July 30, 2020. Results: We identified 66 patients with pneumomediastinum and a diagnosis of COVID-19. The prevalence found was 3.2%, 81.8% corresponded to males, the average age was 53.4 years, the average length of stay in hospital was 22.98 days, the most frequent comorbidities were obesity, diabetes and hypertension. 95.5% did not report smoking and 89.4% were not on mechanical ventilation. The most frequent symptoms were dyspnea, non-productive cough and chest pain. 69.7% of patients had a fatal outcome. Pulmonary tomography showed that 43. 9% presented moderate grade pneumomediastinum and with respect to pulmonary involvement 97% presented a typical bilateral pattern, the peak and progressive stage presented in 56.1% and 31.8% respectively and the most frequent percentage of pulmonary involvement was severe (53%). A percentage of lung involvement higher than 50% correlated directly with the severity of the pneumomediastinum (p<0.05). The average ferritin was 884.58 ug/ml, D-dimer 5.1 mg/ml, DHL 595. 55 IU/L, PCR 150.7 mg/L, lymphocytes 825.1 c/mm3, lactic acid 1.99 mmol/L, PCT 0.78 ng/ml, IL6 313 pg/ml and PaFiO2 171.5 mmHg. Conclusion: Spontaneous pneumomediastinum is a frequent complication in patients with COVID-19, being an indicator of poor evolution.(AU)

Type 2 diabetes: New anti-diabetics and therapeutic strategy for military pilots and planes, combat vehicles and warship crews

The training of combat, transport or helicopter pilots and flight, combat vehicles and warship crews imply a big effort in terms of economic resources, time and logistics for our Armed Forces (FAS). Therefore, it is the responsibility of the Military Health Service to maintain the aptitudes and the skills of our personnel in the best possible conditions for the longest period of time, thus procuring the maximum operating capacity required for the accomplishment of their missions. In this paper it is reviewed and proposed anti-diabetic drugs that may be safely used by pilots, flight, combat vehicles and warship crews, appreciating those that do not produce hypoglycemia neither cause side effects that can compromise the operating capacity. It is recommended and encouraged personnel with pre-diabetic condition to modify their life style and to initiate treatment with metformin, in order to delay or to avoid the onset of diabetes and extend their operating life. It is also encouraged the use of those anti-diabetic agents that best preserve the function of the pancreatic beta cell, therefore delaying the need for insulin based therapy

la formación de un piloto de combate, transporte o helicóptero, tripulaciones de vuelo y vehículos de combate y dotaciones de buques de guerra, supone un gran esfuerzo en cuestión de recursos económicos, de tiempo y medios logísticos para nuestras Fuerzas Armadas (FAS). Por tanto, es responsabilidad de la Sanidad Militar velar por mantener en las mejores condiciones y durante el mayor tiempo posible las aptitudes y capacidades de nuestro personal de vuelo, vehículos de combate y embarcado, procurando así la máxima operatividad para el cumplimiento de las misiones que el mando pudiera requerir. En este artículo se hace una revisión y propuesta de aquellos fármacos antidiabéticos susceptibles de ser utilizados con seguridad por pilotos, tripulaciones de aeronaves y vehículos de combate y dotaciones de buques de guerra, valorando que no produzcan hipoglucemias ni causen efectos secundarios que comprometan la operatividad. Se recomienda y estimula a aquellos que presenten un estado prediabético a modificar su estilo de vida y tratamiento con metformina para retrasar o evitar la aparición de una diabetes prolongando su vida operativa. Se estimula a quienes presenten una diabetes tipo 2 la utilización de aquellos antidiabéticos que mejor preserven la función de la célula beta para retrasar la necesidad de tratamiento insulínico

El Cuerpo Militar de Sanidad en la Investigación de Accidentes Aéreos / The role of Military Health Service in Aircraft Accident Investigation

La investigación de un accidente o incidente aéreo puede ser simple o enormemente compleja. El proceso de investigación puede conducir a la elaboración de un informe directo y conciso o lo más frecuente, significa un largo camino de recopilación, análisis, estudio y finalmente la elaboración de posibles conclusiones. En este proceso, los aspectos médicos, psicológicos, ambientales, psicosociales o ergonómicos englobados en el término genérico de factores humanos cobran una especial relevancia, atribuyéndose hasta un 60-80% de causas directas o coadyuvantes al mismo. En este trabajo se revisan los antecedentes jurídicos y base legal en la que se apoya la Comisión para la investigación técnica de accidentes de aeronaves militares (CITAAM), así como sus atribuciones, organización y composición, sus funciones generales y más concretamente las encomendadas al vocal médico de la misma. Desde su creación en 1994, la experiencia acumulada ha sido enorme, haciéndose mención de algunos datos de interés estadístico pero señalando también la labor de formación realizada y su proyección nacional e internacional, sobre todo en el marco de la OTAN (AU)

Aircraft Accident Investigation means a complex task in order to identify the major causes which lead to the mishap. Investigation process end in a technical report, which encloses a large amount of information and data gathering documentation, to be studied, analyzed and lines of inquiry established to finally produce the appropriate conclusions. Medical, psychological, environmental, psychosocial and ergonomic faces of the investigation are framed in the so called human factors, which actually leads to 60-80% of the causal factors of accidents. In this report we have reviewed the legal basis in which the CITAAM is supported, competencies, organization and composition, general functions and specifically responsibilities of the medical representative in the board. Since the establishment of the CITAAM in 1994 the experience accumulated has been very wide-ranged and we show some statistical data and work produced in education and instruction, as well as the national and international relationships mostly in the NATO frame (AU)

Seguimiento evolutivo de la influencia del cese del hábito tabáquico en una población sana sobre la concentración sérica de lípidos / Evolutive follow-up of the influence of smoking cessation in a healthy population on lipid serum concentration

Hipótesis: El tabaco repercute sobre el perfil lipídico de los fumadores. Las campañas contra el hábito de fumar han propiciado una caída en su consumo. Objetivos: Se trata de estudiar los cambios en el perfil de lípidos en sangre tras un seguimiento de once años en función de las variaciones en la prevalencia del tabaquismo. Material y métodos: Población de 1.795 varones sanos con edades comprendidas entre 30 y 50 años. Se determinó la prevalencia del hábito tabáquico, colesterol total, c-LDL, c-HDL, triglicéridos e índice de masa corporal (IMC) en los años 1995, 2000 y 2005. Resultados: Las tasas de tabaquismo inicial y final fueron del 36,1 y 19% respectivamente. Tras la caída del consumo de tabaco, los índices de masa corporal inicial y final fueron de 24,8 ± 3,2 y 25,3 ± 3,3 kg/m2, respectivamente, sin encontrarse diferencias significativas entre ambos. El colesterol descendió un 7%. El c-HDL pasó de 46,0 ± 10 a 56,0 ± 14 mg/dl. Los triglicéridos descendieron en un 12%. No hubo diferencias significativas en las concentraciones de c-LDL. Conclusiones: A lo largo de los once años de estudio, se produjo una caída en el consumo de tabaco en esta población superior a la media nacional. Se observó un incremento significativo de c-HDL y un descenso de los triglicéridos y del colesterol total. No se modificaron las cifras de c-LDL (AU)

Hypothesis: Tobacco has a repercussion on the lipid profile of smokers. Anti-smoking campaigns have brought about a fall in tobacco consumption. Objectives: It has been aimed to study the changes in the lipid profile in blood after an 11-year follow-up based on variations in smoking prevalence. Material and methods: A population of 1795 healthy males, aged 30 to 50 years. Prevalence of smoking was determined as well as total cholesterol, LDL-c, HDL-c, triglycerides and body mass index (BMI) for the years 1995, 2000 and 2005. Results: The rates of initial and final smoking habit were 36.1% and 19%, respectively. After the fall in tobacco consumption, the initial and final body mass indexes were 24.8 ± 3.2 and 25.3 ± 3.3 kg/m2, respectively, without finding significant differences between them. Cholesterol decreased by 7%. HDL-c went from 46.0 ± 10 to 56.0 ± 14 mg/dl. Triglycerides decreased by 12%. There were no significant differences in the LDL-c concentrations. Conclusions: During the 11 years of the study, there was a greater decrease in the consumption of tobacco in this population than in the national mean. A significant increase was observed of HDL-c and decrease of triglycerides and total cholesterol. The LDL-c le vels were not modified (AU)

Síndrome por movimiento en simuladores de helicóptero / Syndrome by movement in shammer

Introduction. Actually the flight shammers are a fundamental part in the programs of the pilots’ training. It is denominated«Syndrome by movement in shammer», to the group of symptoms and signs that appear in the pilot during the flight in the shammer. The main objective of the present study is to determine the symtomatology incidence that appears during the flight in shammer and to relate it with diverse variables. Methods. 125 pilots of helicopter of the Spanish armed forces were studied that went to the Center of Shammers of F.A.M.E.T to carry out a period of training in shammer. The study has been performed with a survey executed by all the fellows, where personal data were included, previous conditions to the flight in the shammer and appearance of symptoms and signs during the flight. Results. The clinic incidence during the flight was of 60.8% (76 pilots). The most frequent symptoms during the flight were fatigue, drowsiness, stomach uneasiness, tired view and sweat. This clinic was increased mainly by the gyros and landings. The intensity of the clinic was bigger in the pilots than they had described bigger susceptibility to the sicknessin real flight and in flight in shammer, in the pilots that described to have had to modify in some occasion the flight in shammer for clinic of sickness and in the pilots that flew in visual and instrumental combined flights or with night vision goggles. Conclusions. The main conclusion of the study is that the cinetosis in shammers is very frequent mainly in those susceptible pilots, independently of its experience and hours of flight (AU)

Los simuladores de vuelo son, hoy en día, una parte fundamental en los programas de entrenamiento de los pilotos. Se denomina Síndrome por movimiento en simulador», al conjunto de síntomas y signos que aparecen en el piloto durante el vuelo en el mismo. El principal objetivo del presente estudio es determinar la incidencia de sintomatología que aparece durante el vuelo en simulador y relacionarla con diversas variables. Material y Métodos. Se estudió a 125 pilotos de helicóptero de las Fuerzas Armadas Españolas que acudieron al Centro de Simuladores de las Fuerzas Aeromóviles del Ejército de Tierra para realizar un periodo de entrenamiento en simulador. El estudio se ha valido de una encuesta estructurada y cumplimentada por todos los sujetos, donde se incluían datos personales, condiciones previas al vuelo en el simulador y aparición de síntomas y signos durante el mismo. Resultados. La incidencia de manifestaciones clínicas durante el vuelo fue del 60,8% (76 pilotos). Los síntomas más frecuentes durante el vuelo fueron fatiga, somnolencia, malestar de estómago, vista cansada y sudoración. Esta clínica se agravó sobre todo por los virajes y aterrizajes. La intensidad de la clínica fue mayor en los pilotos que habían descrito mayor susceptibilidad al mareo en vuelo real y en vuelo en simulador, en los pilotos que describieron haber tenido que modificar en alguna ocasión el vuelo en simulador por clínica de mareo y en los pilotos que volaron en vuelos combinados visuales e instrumentales o con gafas de visión nocturna. Conclusiones. La principal conclusión del estudio es que la cinetosis en simuladores s muy frecuente, sobre todo en aquellos pilotos susceptibles, independientemente de su experiencia y horas de vuelo (AU)

Reconocimientos correspondientes a procesos Selectivos. Experiencia y aspectos aeromédicos / Medical examinations in selective courses. Aeromedical features and experiences

Antecedentes: Los procesos correspondientes a la evaluación psicofísica del personal aspirante a Academias Militares, sin duda tienen una enorme trascendencia y muy específicamente en su perspectiva médico-aeronáutica, y desarrollo futuro de responsabilidades de vuelo en nuestras FAS. En este trabajo se analiza la experiencia acumulada en el Centro de Instrucción de Medicina Aeroespacial (CIMA), respecto a aspectos tan críticos como las causas de no aptitud y consideraciones derivadas. No tenemos constancia que con anterioridad se hayan publicado datos precisos relacionados en éste sentido. Material y Método: Se han revisado los reconocimientos correspondientes a los años comprendidos entre el 2002 y 2006. Para ello se ha recopilado todos los datos procedentes de las hojas de reconocimiento y su resultado final, considerando las causas de no aptitud establecidas en la Orden 387/2002 y modificaciones sucesivas. Resultados: Se han recogido los datos globales, incluyendo aspectos demográficos, así como las causas de no aptitud mas frecuentes. Además se citan las variaciones anuales de las principales causas de exclusión. Las causas oftalmológicas, las asociadas a transgresiones ponderales y otorrinolaringológicas se muestran como las más críticas, sobre todo a expensas de las primeras. Discusión: Se comentan y comparan los resultados obtenidos con la experiencia de países de nuestro entorno, específicamente en los aspectos relativos a las características de los reconocimientos, grupos y causas de exclusión. Conclusiones: La aplicación correcta del cuadro de requisitos psicofísicos, ha demostrado que la incidencia de determinadas patologías ligadas al aparato visual tienen una gran trascendencia cuantitativa, pero el resto de alteraciones evaluadas no por su menor incidencia tienen un menor peso por su trascendencia en la seguridad de vuelo (AU)

Background: The psycho-physic personnel evaluation courses, for the Military Academies’ candidates, must be seen of an enormous transcendence, undoubtedly, specifically in the aeromedical sight, concerning to the future development of flying responsibilities within our Armed Forces. The acquired experience of the CIMA (Centro de Instrucción de Medicina Aeroespacial) about such features, like reasons for candidates rejection and derived questions, is studied in this paper. We have no evidence about data published studies in this line. Methods: The medical examinations between 2002 and 2006 have been checked. The data sheet of medical examinations were collected, as much as the final report of each one, considering the legal reasons for rejection, established by Order 387/2002 and following dispositions. Results: The global data collected, including demographic features, include positive and negative reports, classified these by frequencies. Main causes for negative reports were analysed by years. Ophthalmologic causes, weight transgressions and otolaryngology were the critical ones, mainly the ocular reasons. Discussion: The obtained results are commented and compared to our social surrounding countries, mainly attending to the examination groups and rejection conditions. Conclusions: A good performance for the psycho-physical application table demonstrates that the incidence of the ocular pathologies are quantitative transcendental, but the weight of the other observed pathologies, despite of their incidence, have not so much influence in flying security (AU)

Seguridad y utilidad de Zaleplon en operaciones aéreas / Efficacy and safety of zaleplon in aviation operations

Fundamento: El insomnio y su tratamiento farmacológico pueden causar incidentes y accidentes aéreos. La normativa aeronáutica internacional sólo autoriza, de modo excepcional y controlado, el consumo de hipnóticos no benzodiacepínicos tipo zolpidem o zopiclona. Sin embargo, zaleplon, un nuevo hipnótico no benzodiacepínico, posee una seguridad farmacológica superior a las de éstos últimos. Objetivo: Evaluar los posibles efectos adversos de zaleplon sobre la función psicomotora de pilotos de aeronave en situación de vuelo simulado en cámara hipobárica durante su entrenamiento fisiológico. Pacientes y método: Participaron 36 pilotos de aeronave, alumnos varones del Ejército del Aire de España, tomaron una única dosis de zaleplon 10 mg o placebo la noche previa a la sesión de entrenamiento fisiológico en cámara hipobárica. El estudio, aleatorizado y doble ciego, valoró la influencia de zaleplon vs placebo sobre la capacidad de atención en condiciones de prehipoxia, hipoxia hipobárica y posthipoxia, utilizando el test de atención Toulouse-Pieron modificado. Resultados: Los valores medios obtenidos en el grupo zaleplon vs el de placebo fueron, respectivamente: 22,11(5,91 y 22,94(9,21 (prehipoxia); 19,17(8,89 y 15,39(7,90 (hipoxia); 29,33(6.27 y 31,44(7,70 (posthipoxia). No existieron diferencias significativas entre ninguno de los va¬lores encontrados en uno y otro grupo. Conclusiones: Tras descartar efectos adversos sobre la capacidad psicomotora en condiciones de hipoxia hipobárica y revisar las evidencias científicas en la literatura biomédica, se concluye que zaleplon puede convertirse en el hipnótico de primera elección en operaciones aéreas

Background: Insomnia and its pharmacological treatment can cause aviation incidents and accidents. International aviation regulations only exceptionally and under controlled conditions authorize the use of non-benzodiazepine hypnotics such as zolpidem or zopiclone. However, zaleplon, a new non-benzodiazepine hypnotic, affords greater pharmacological safety than these latter drugs. Objective: To evaluate the potential adverse events of zaleplon on psychomotor function among aviation pilots under simulated flight conditions in a hypobaric chamber in the course of physiological training. Patients and method: Thirty-six male pilots in training and belonging to the Spanish Air Force were administered a single dose of zaleplon 10 mg or placebo the night before a physiological training session in a hypobaric chamber. The randomized, double-blind study assessed the influence of zaleplon versus placebo on sustained alertness and fatigue resistance under conditions of prehypoxia, hypobaric hypoxia and posthypoxia, based on the modified Toulouse-Pieron alertness test. Results: The mean values obtained in the zaleplon versus the placebo group were respectively: 22.11(5.91 and 22.94(9.21 (prehypoxia); 19.17(8.89 and 15.39(7.90 (hypoxia); 29.33(6.27 and 31.44(7.70 (posthypoxia). There were no significant differences between any of the recorded values in either group. Conclusions: After discarding potential adverse effects on psychomotor capacity under conditions of hypobaric hypoxia and reviewing the sciéntific evidence in the biomedicalliterature, it is concluded that zaleplon may become the first-choice hypnotic in aviation operations

Síndrome del pasajero de clase económica / Economic class syndrome

El grado de confort, seguridad y rapidez conseguido en el transporte por vía aérea, hacen de éste medio un cada vez más popular sistema de transporte, que es utilizado por un gran número de pasajeros. La horquilla de edad en el pasaje se ha ampliado y la accesibilidad a un espectro social cada vez más extenso, ha hecho que el número de pasajeros/año se multiplique. Durante los últimos meses y fundamentalmente producido por la muerte de una pasajera como consecuencia de un tromboembolismo pulmonar (TEP) durante un viaje desde Australia a Europa, se ha discutido sobre el denominado Síndrome del Pasajero de Clase Turista o Económica, en numerosos foros internacionales y se han publicado datos todavía incompletos sobre éste problema. Muchas preguntas todavía no han respondido de acuerdo a una base científica ¿Cuántos casos?, ¿Se asocia al vuelo?, ¿Cómo podemos prevenirlo?.En este trabajo se analiza la incidencia según la bibliografía consultada, así como aspectos epidemiológicos, fisiopatológicos, factores de riesgo, diagnóstico, probabilidad y medidas preventivas que por parte del usuario, compañías y autoridades aeronáuticas se deberían establecer para evitar en la medida de los posible ésta complicación. Finalmente se discute las bases fisiopatológicas en las que se desarrolla la trombosis venosa profunda (TVP) y el tromboembolismo pulmonar, tratando de definir éste síndrome como consecuencia de factores relacionados con el medio aeronáutico y en el contexto eventual de su aparición durante el vuelo o como consecuencia directa de éste (AU)

Comfort, safety and time saving makes air travel more and more popular and widely use by an increased number of people in a range of extended age frame. Recent concerns in the global news have again raised an issue about the association of thromboembolic disease and air travel. Although there are numerous studies in the literature examining venous thromboembolic disease (VTE), variability of population demographics makes difficult a right and prospective assessment in the context of the cabin environment and air travel. Literature review clearly demonstrate that VTE is multicausal in nature, resulting in differing etiologic and predisposing factors across different age groups. Many questions are still to be answered, How many cases?, Direct association to Air Travel?, How to prevent it in the aviation environment?. In this paper we analize the incidence of VTE and some additional epidemiological aspects, risk and predisposing factors, diagnostic, and preventive measures given by the airline, the user, aviation authorities, aeromedical especialist in order to cope this complication. Finally we discuss the physiophatological bases in which VTE is developed and related considerations of this symdrome in the context of the aviation environment (AU)

[Economic class syndrome]. / Síndrome del pasajero de clase económica.

Comfort, safety and time saving makes air travel more and more popular and widely use by an increased number of people in a range of extended age frame. Recent concerns in the global news have again raised an issue about the association of thromboembolic disease and air travel. Although there are numerous studies in the literature examining venous thromboembolic disease (VTE), variability of population demographics makes difficult a right and prospective assessment in the context of the cabin environment and air travel. Literature review clearly demonstrate that VTE is multicausal in nature, resulting in differing etiologic and predisposing factors across different age groups. Many questions are still to be answered, How many cases?, Direct association to Air Travel?, How to prevent it in the aviation environment? In this paper we analyze the incidence of VTE and some additional epidemiological aspects, risk and predisposing factors, diagnostic, and preventive measures given by the airline, the user, aviation authorities, aeromedical especialist in order to cope this complication. Finally we discuss the physiopathological bases in which VTE is developed and related considerations of this syndrome in the context of the aviation environment.

Trastornos menstruales en tripulantes de cabina de pasajeros (TCP) / Menstrual disorders in flight attendants

INTRODUCCIÓN:El objetivo de este estudio es determinar la incidencia de alteraciones en el ciclo menstrual de las azafatas de una compañía aérea y su relación con factores propios del medio aeronaútico tales como, la exposición mantenida a un medio hipobárico y a un determinado ambiente de cabina, duración y recorrido de vuelos y otros factores como, ambiente de trabajo (estrés, cambios horarios...), edad, patología médico y/o ginecológica y toma de fármacos. MATERIAL Y MÉTODO: Realizamos un estudio mediante un cuestionario anónimo y voluntario entre las azafatas que pertenencían a la plantilla de la compañía Iberia. RESULTADOS: Respondieron a la encuesta 614 azafatas con edades comprendidas entre los 20 y 58 años siendo la media de 37,38 años. Del total de la muestra un 44,1 por ciento referían alteraciones menstruales. Encontramos una relación estadística significativa entre la presencia de transtornos menstruales y la edad, los años efectivos de vuelo y otros factores tales como el vuelo en aviones que realizan trayectos intercontinentales y continentales. Según los resultados obtenido la edad juega un papel fundamental en la presencia de estos trastornos (AU)

INTRODUCTlON: The aim of this study is to analyze the incidence of changes and disturbances in the menstrual cycle in a group of flight attendants (FA) in relation to aviation environmental factors such hipobaria exposure, cabin pressure, length and route of flight and other factors such occupational stress, age, medical, gynecological disturbances and use of medication. MATERIAL AND METHODS: We carried out a survey by voluntary and anonymous questionnaire among flight attendants currently assigned to the fleet of lBERIA Airlines. RESULTS: 614 FA answered the questionnaire. The average age of the FA was 37,38 (range 20-58). Of the 614 FA surveyed 44,1% reported menstrual disorders. We found a relation statistically significant between the presence of menstrual disorders and age, flying time, intercontinental and continental flights. The age is un important factor in menstrual disorders in night attendants (AU)

Ambulatory blood pressure after renal transplantation.

Renal transplantation has been a usual medical practice in developed countries for several decades. A large number of studies report the excellent results obtained with such a practice. The survival of the graft, although able to be improved, is excellent and gives a great deal of hope to patients with renal insufficiency. The high level of investigation into immunosuppressor drugs offers, almost continuously, more efficient and better tolerated products. Paradoxically, the usual problems of patients with a renal transplant are not immunological but cardiovascular. Elevated serum cholesterol levels, obesity, diabetes and other cardiovascular risk factors (CVRFs) are usual in these patients, arterial hypertension (AHT) being the most frequent. Nephrologists are increasingly using ambulatory blood pressure monitoring (ABPM) on a daily basis. In the last 10 years, we have obtained highly valuable and interesting results with this technique which have allowed us to study and understand with greater precision the relationship of AHT to the kidney. Here we analyse and review the most relevant aspects of ABPM in the different stages of kidney disease, with special emphasis on renal transplantation.

Aminoglutethimide, a steroidogenesis inhibitor, abolishes hormonal induction of ornithine decarboxylase in steroidogenic tissues: evidence for its role as cAMP-dependent protein kinase inhibitor.

Aminoglutethimide (AMG), a potent inhibitor of steroidogenesis used in the treatment of breast cancer and some adrenal pathologies, abolished the induction of ornithine decarboxylase (ODC) elicited by peptide hormones and by dibutyryl-cAMP in steroidogenic tissues. This effect seems to be related to an inhibition of cAMP-dependent protein kinase (IC50 = 287 microM) rather than blockade of the steroidogenic pathway. This inhibition may explain some of the effects observed in AMG treatment which cannot be ascribed to its direct effect on the cytochrome P450scc complex or aromatase. Taking into account that ODC, the rate-limiting enzyme in polyamine synthesis, is elevated in many types of cancer and that overexpression of this enzyme is associated with cell transformation, one may speculate that the inhibitory action of AMG on protein kinase A represents a positive colateral effect of this drug in cancer therapy.

Determination of lumbar muscular activity in helicopter pilots: a new approach.

BACKGROUND: Discomfort in the lumbar region is a frequent complaint of helicopter pilots. Two factors that helicopter crewmembers relate to back pain are exposure to vibration and poor posture during flight, because during flight the seat and controls force the pilot to adopt an asymmetric posture. Repeated exposure to these adverse flight conditions could cause pathological changes in the spine. The purpose of this study was to compare right and left sided lumbar muscular activity in helicopter pilots under real flight conditions, using surface electromyography (SEMG) to demonstrate the effects of asymmetrical posture on the musculoskeletal system. An attempt was also made to correlate lumbar muscular activity with environmental factors and such variables as type of flight, type of helicopter, duration of flight, age, physical fitness, and height. METHODS: Right- and left-sided lumbar electrical activity were measured using two-channel SEMG during 35 flights in 2 types of helicopter and a cockpit mock-up. RESULTS: There was a statistically significant increase in right-sided lumbar activity when related to the duration of flight. CONCLUSIONS: The data showed that when the pilot used the manual controls during flight, he did not maintain a symmetrical posture and contracted one side more than the other. We think the relationship between the greatest right-sided contraction and flight duration is due to maintaining an asymmetric posture over a long period. We also noted a tendency towards greater right lumbar musculature activity in older pilots.

Plan de cuidados específicos en pacientes ingresados en programa de hemodiálisis / Specific care plan for patients in the hemodialysis program

Con este trabajo a modo de informe, pretendemos disminuir o subsanar en lo posible, las alteraciones surgidas en el trabajo diario, en lo que se refiere al manejo de pacientes renales en tratamiento mediante hemodiálisis, que por cualquier motivo permanezcan ingresados en este hospital.Se trata de facilitar la labor de los profesionales que intervienen en su cuidado, intentando dar a conocer esas peculiaridades que hacen del enfermo renal alguien "distinto" a otros pacientes, estableciendo un contacto más estrecho con las distintas unidades de hospitalización, para facilitar la coordinación y en definitiva aumentar la calidad de los cuidados.Intentamos presentar al enfermo renal tratando los aspectos generales de estos pacientes, su dieta y control de líquidos, accesos vasculares, tratamientos y pruebas complementarias. (AU)

Postnatal exposure to androgens alters renal ornithine decarboxylase ontogeny and abolishes renal sexual dimorphism in mice.

The mouse kidney presents marked sexual dimorphism, manifested not only in renal size but also in the subcellular structure and enzyme activity. Ornithine decarboxylase (ODC), a key enzyme in the biosynthetic pathway of polyamines, is induced in the kidney by androgens, and its activity is higher in the kidney of male mice. The renal differences between male and female mice are not manifested during the first weeks of life and start to be expressed after weaning, simultaneously with the increase in plasma testosterone concentration. Treatment of newborn mice before postnatal day 21 with a single dose of testosterone propionate (TP, 200 microg/animal) did not increase renal ODC activity or renal size. From day 21 the same treatment elicited significant increases in renal ODC, especially in females where the basal activity of control animals was much lower than in males. The repeated injection of TP during the first 10 days of life (200 microg/animal, days 1, 4, 7 and 10) promoted an early increase in renal ODC activity but abolished the physiological rise observed in male mice at puberty and adulthood. This treatment dramatically reduced the secretion of the sexual hormones, testosterone, estradiol and progesterone, by the gonads, and diminished renal size as well as ODC and beta-glucuronidase activities in male mice. Stanozolol produced effects similar to those of TP, while the nonsteroidal antiandrogen, flutamide, did not apparently affect the normal development of the male or female kidney. The results indicate that: (a) kidney sexual dimorphism is not congenital; (b) neonatal androgens are not required to induce the sexual dimorphism of the mouse kidney; (c) the neonatal kidney is unresponsive to testosterone; (d) the premature and repeated exposure to supraphysiological levels of testosterone may accelerate the ontogeny of renal ODC but can abolish later testosterone secretion and hence alter the sexual characteristics of the male kidney, and (e) the postnatal treatment with androgens does not affect the response of the adult kidney to exogenous androgens. One can conclude that the postnatal manipulation of androgens may accelerate the development of the mechanisms of androgen responsiveness in some tissues but it may alter neural structures, probably the GnRH pulse generator, that control testosterone secretion.

Hypokalemia alters sex hormone and gonadotropin levels: evidence that FSH may be required for luteinization.

Hypokalemia produced different effects on steroid sex hormone concentrations in plasma and ovary in the mouse. Estradiol levels were slightly increased, whereas circulating progesterone was markedly decreased in all estrous periods. The preovulatory surge of gonadotropins and the secondary surge of follicle-stimulating hormone (FSH) at estrus were also decreased, but basal levels of both gonadotropins were unaffected. Supplementation with luteinizing hormone (LH), FSH, or gonadotropin-releasing hormone (GnRH) at proestrus rapidly normalized plasma and ovarian progesterone levels at this stage of the estrous cycle. Plasma progesterone levels at diestrus were restored only by combined treatment, at the periovulatory stage, with LH and FSH or GnRH but not by LH or FSH alone. The results demonstrate a lack of steroidogenic activity in the corpus luteum of the potassium-deficient mice and, furthermore, that FSH plays an important role in luteinization in the hypokalemic mice. We conclude that alteration of the transcellular potassium gradient may affect the regulation of the periovulatory surge of gonadotropins and progesterone secretion, probably by altering the release of GnRH from the hypothalamus. In addition, the results suggest that FSH may play a certain role as a luteotropic hormone in mice.

Interference of the antihormone RU486 in the determination of testosterone and estradiol by enzyme-immunoassay.

The antihormone RU486 (mifepristone, 11beta-(4-dimethylaminophenyl)-17beta-hydroxy-17alpha-(prop- 1-ynyl)-estra-4,9-dien-3-one) is currently used in many endocrinological studies and in clinical practice as a contraceptive agent. The results presented here indicate that the synthetic steroid RU486 may interfere in determinations of testosterone and estradiol when using some commercial kits. Although the cross reactivity is low (0.30% for testosterone and 0.16% for estradiol), in animal experiments RU486 doses higher than 5 mg/kg may produce false positive results in the estimation of plasma testosterone (specially in castrated male or female mice) or estradiol concentrations, even in samples obtained 48 h after the administration of this antihormone.

[Advanced auriculoventricular block of atypical presentation after acute myocardial infarct in sleep apnea syndrome]. / Bloqueo auriculoventricular avanzado de presentación atípica tras infarto agudo de miocardio en el síndrome de apnea del sueño.

We report a case of an adult male in whom, one week after an anterior acute myocardial infarction, we documented nocturnal episodes of type II second degree atrio-ventricular heart block, including advanced heart block episodes (4:1). An electrophysiologic study did not show atrio-ventricular conduction abnormalities, so we suspected a possible sleep apnea syndrome, which was confirmed with a polysomnographic study. It was observed that advanced heart block episodes were preceded by significant decreases in arterial oxygen saturation. These episodes disappeared with continuous positive air pressure ventilation.