Executive Functioning and Language in a Pediatric Population with Autism Spectrum Disorders and Epilepsy: A Comparative Study.

In recent years, there has been an increase in the prevalence of comorbidity between ASD and epilepsy in the pediatric population. Children with ASD and epilepsy often exhibit greater impairments in executive functions such as cognitive flexibility, planning, inhibition, and emotional control, as well as in language dimensions such as phonology, semantics, morphosyntax, and pragmatics. These impairments can significantly impact their maturation and development. The aim of this study was to assess and compare the executive functioning and language skills of 150 participants, divided into three groups: one with ASD only, another with epilepsy only, and the third group with both ASD and epilepsy. The study utilized the Behavior Rating Inventory of Executive Function (BRIEF-2) and Neuropsychological Evaluation of Executive Functions in Children (ENFEN) to assess executive functions, and Clinical Evaluation of Language Fundamentals 5 (CELF-5) to evaluate language skills. The results indicated that participants with this comorbidity had lower scores in both executive functioning and language skills compared to children with only ASD or epilepsy. The presence of epilepsy significantly limits the executive and linguistic performance of children with ASD, negatively affecting language acquisition, functionality, and the ability to carry out basic life activities independently.

The Comprehension of Grammatical Structures in a Pediatric Population with ASD and Epilepsy: A Comparative Study.

Autism Spectrum Disorder (ASD) and epilepsy represent a comorbidity that negatively influences the proper development of linguistic competencies, particularly in receptive language, in the pediatric population. This group displays impairments in the auditory comprehension of both simple and complex grammatical structures, significantly limiting their performance in language-related activities, hampering their integration into social contexts, and affecting their quality of life. The main objective of this study was to assess auditory comprehension of grammatical structures in individuals with ASD and epilepsy and compare the results among the three groups. A non-experimental cross-sectional study was designed, including a total of 170 participants aged between 7 and 9 years, divided into three groups: a group with ASD, a group with epilepsy, and a comorbid group with both ASD and epilepsy (ASDEP). The comprehension of grammatical structures was assessed using the CEG and CELF-5 instruments. Statistical analyses included MANOVA and ANOVA to compare scores between groups to verify associations between study variables. The results indicate that the group with ASD and epilepsy performed worse compared to the ASD and epilepsy-only groups, respectively. Additionally, a significant and directly proportional association was observed among all variables within the measures of grammatical structure comprehension. The neurological damage caused by epilepsy in the pediatric population with ASD leads to difficulties in understanding oral language. This level of functioning significantly limits the linguistic performance of these children, negatively impacting their quality of life and the development of core language skills.

The Linguistic-Cognitive Profile in an Adult Population with Parkinson's Disease and Deep Brain Stimulation: A Comparative Study.

Introduction. Individuals with Parkinson's disease (PD) exhibit general impairments, particularly non-motor symptoms that are related to language, communication, and cognition processes. People with this disease may undergo a surgical intervention for the placement of a deep brain stimulation device, which improves their motor symptoms. However, this type of intervention leads to a decline in their linguistic and cognitive abilities that becomes increasingly noticeable as the disease progresses. Objective. The objective of this research was to compare the performance and linguistic-cognitive profile of individuals with Parkinson's disease who underwent deep brain stimulation treatment based on the stage of the disease. Method. A total of 60 participants who were diagnosed with PD by their reference hospital were selected. These participants were divided into three groups based on the stage of the disease that they were in, forming three groups: a Stage I group (n = 20), a Stage II group (n = 20), and a Stage III group (n = 20). The linguistic-cognitive profile was assessed using the MoCA, ACE-III, and MetAphas tests. The design of this study was established as a quasi-experimental, cross-sectional investigation, and statistical analysis was performed using MANOVA to compare the scores between the study groups. Results. The results indicate that individuals in Stage I exhibit better linguistic and cognitive performance compared to the other groups of participants in Stage II and Stage III, with statistically significant differences (p < 0.05). Conclusion. In conclusion, the progression of PD leads to significant linguistic and cognitive decline in individuals with this disease who have a deep brain stimulation device, greatly limiting the autonomy and quality of life for people with PD.

The Influence of Sleep Disorders on Neurobiological Structures and Cognitive Processes in Pediatric Population with ASD and Epilepsy: A Systematic Review.

Autism Spectrum Disorder (ASD) and epilepsy are increasingly prevalent comorbidities in our society. These two disorders are often accompanied by other comorbidities, such as sleep disorders, significantly impacting the quality of life of individuals with ASD and epilepsy. To date, clinical approaches have primarily been descriptive in nature. Therefore, this study aimed to analyze the relationship between ASD, epilepsy, and sleep disorders, exploring neurobiological dysfunctions and cognitive alterations. A total of 22 scientific articles were selected using a systematic literature review following the criteria established using the PRISMA model. The selected articles were gathered from major databases: Medline, PubMed, PsycINFO, Google Scholar, and Web of Science. Inclusion criteria specified that study participants had an official diagnosis of ASD, the article precisely described the evaluation parameters used in the study participants, and individual characteristics of the sleep disorders of the study participants were specified. The results indicate, firstly, that the primary cause of sleep disorders in this population is directly linked to abnormal serotonin behaviors. Secondly, significant alterations in memory, attention, and hyperactivity were observed. In conclusion, sleep disorders negatively impact the quality of life and neurocognitive development of the pediatric population with ASD and epilepsy.

Analysis of the Mechanical Properties of a Stabilized Subgrade Type Soil under a Sustainable Approach for Construction.

This article presents an experimental study to analyze the mechanical properties of a soil stabilized with ordinary Portland cement (OPC) under a sustainable approach consisting of a significant substitution of OPC for sugarcane bagasse ash (SCBA) to reduce the quantity of cement used in the stabilization, reaching the necessary mechanical requirements for its use as a subgrade layer. Soil specimens were elaborated with 3%, 5%, and 7% OPC as a stabilizing agent by weight of the soil. These mixtures were then partially substituted with 25%, 50%, and 75% SCBA, with these percentages being by weight of the stabilizer (OPC). Compaction, compressive strength, and California bearing ratio (CBR) tests were performed to evaluate the mechanical properties of the specimens. The results indicate that a 25% substitution of OPC by SCBA shows a similar performance to the mixture with only Portland cement, so a reduction in OPC use can be made. Further, with a substitution of 100% OPC by SCBA, the CBR of natural soil without stabilizers is improved.

Emotional and behavioral alterations and their relationship with executive functioning in the pediatric population with autism spectrum disorder and epilepsy: a comparative study.

Introduction: The pediatric population with Autism Spectrum Disorder (ASD) and epilepsy presents behavioral and emotional alterations that hinder their correct developmental maturation as well as their integration in different contexts such as school, family or social. This population shows atypical behavioral and emotional patterns, with difficulties in emotional regulation, understanding of emotions, aggressiveness, or low frustration tolerance. They also present alterations in executive functions, which significantly influence the emotional and behavioral characteristics of this population. Research suggests that epilepsy worsens the emotional, behavioral, and executive functioning status. Objective: To explore differences in behavioral, emotional, and executive functioning profile in individuals with a diagnosis of ASD, epilepsy, and ASD with epilepsy. Method: In this quasi-experimental and cross-sectional study, a total of 170 participants were selected and distributed into three groups: a group of participants with ASD, a group with epilepsy, and a group of participants with ASD and epilepsy. The SENA, BASC-3, and ENFEN tests were administered to verify the behavioral, emotional, and executive functioning profile in the three groups. Results: The results indicate that individuals diagnosed with ASD and epilepsy present greater emotional, behavioral, and executive functioning alterations compared to those who only present ASD or epilepsy. Conclusion: Individuals with ASD and epilepsy present significant alterations in emotional, behavioral, and executive functioning processes, which hinder their adaptation to different contexts, as well as decreasing their quality of life and that of their family.

Evaluating pollution-related damage and restoration success in urban forests with participatory monitoring and digital tools.

Peri-urban forest monitoring requires indicators of vegetation damage. An example is the sacred fir (Abies religiosa) forests surrounding Mexico City, which have been heavily exposed to tropospheric ozone, a harmful pollutant, for over 4 decades. We developed a participatory monitoring system with which local community members and scientists generated data on ozone tree damage. Santa Rosa Xochiac rangers (13) used the digital tool KoboToolBox to record ozone damage to trees, tree height, tree ages, tree condition, tree position, and whether the tree had been planted. Thirty-five percent of the trees (n = 1765) had ozone damage. Younger trees had a lower percentage of foliage damaged by ozone than older trees (p < 0.0001), and asymptomatic trees tended to be younger (p < 0.0001). Symptomatic trees were taller than asymptomatic trees of the same age (R2 c  = 0.43, R2 m  = 0.27). Involving local communities facilitated forest monitoring and using digital technology improved data quality. This participatory system can be used to monitor forest condition change over time and thus aids restoration efforts driven by government or local communities' interests, facilitating local decision-making.

Evaluación del daño relacionado a la contaminación y del éxito de la restauración de los bosques urbanos con un monitoreo participativo y herramientas digitales Resumen El monitoreo de los bosques periurbanos requiere indicadores de daños en la vegetación. Un ejemplo son los bosques de abeto (Abies religiosa) que rodean la Ciudad de México, pues desde hace más de 4 décadas han estado expuestos al ozono troposférico, un contaminante nocivo. Desarrollamos un sistema de monitoreo participativo con el que miembros de la comunidad local y científicos generaron datos sobre los daños causados por el ozono en los árboles. Los guardabosques de Santa Rosa Xochiac (133) utilizaron la herramienta digital KoboToolBox para registrar los daños causados por el ozono en los árboles, su altura, edad, estado, posición y si eran árboles plantados. El 35% de los árboles (n = 1,765) presentó daños por ozono. Los árboles más jóvenes tenían un menor porcentaje de follaje dañado por el ozono que los árboles más viejos (p<0.0001), y los árboles asintomáticos tendían a ser más jóvenes (p<0.0001). Los árboles sintomáticos eran más altos que los asintomáticos de la misma edad (R2 c = 0.43, R2 m = 0.27). La participación de las comunidades locales facilitó el monitoreo forestal y el uso de tecnología digital mejoró la calidad de los datos. Este sistema participativo puede utilizarse para monitorear los cambios en el estado de los bosques a lo largo del tiempo y contribuir a los esfuerzos de restauración impulsados por el gobierno o las comunidades locales, facilitando la toma de decisiones a nivel local.

Relationship of epilepsy on the linguistic-cognitive profile of children with ASD: A systematic review of the literature.

Introduction: The prevalence of comorbidity between epilepsy and Autism Spectrum Disorder (ASD) in the pediatric age increased significantly in recent years. The onset of epilepsy negatively influences the abilities of the user with ASD. Thus, epilepsy will be a disabling factor that will reduce the cognitive-linguistic skills of users with ASD. The main objective of this work is to review the current scientific literature and to compare the relationship of epilepsy on the development of cognitive and linguistic skills of children with ASD. Methods: In this regard, a systematic search was carried out in the main sources (Medline, PubMed, WOS, ResearchGate and Google Scholar). 481 articles were identified, from which, after meeting the different inclusion and exclusion criteria, a total of 18 studies of relevance to the objectives of this work were selected. Results: The results reflect that, at a global level, epilepsy significantly influences the performance of cognitive- linguistic skills in people with ASD. Discussion: In conclusion, epilepsy in the ASD population leads to a reduction in cognitive and linguistic abilities, which respond to the different types of epilepsy and their location, significantly impacting the quality of life and basic activities of daily living of the user with ASD.

Portland Cement-Based Grouts Enhanced with Basalt Fibers for Post-Tensioned Concrete Duct Filling.

In post-tensioned systems, grouts act as a last line of defense to prevent the penetration of harmful compounds such as chlorides, moisture and other substances that cause corrosion in the prestressing steel. For this reason, improving grouts results in the enhancement of the overall durability of the structure. In this study, the physical properties of grouts with basalt microfiber additions in the amounts of 0.03, 0.07 and 0.10% with respect to the mix volume were evaluated. The fresh properties included flowability and unit mass. Specimens were fabricated to evaluate drying shrinkage, compressive strength, air permeability and rapid permeability to chloride ions. The incorporation of basalt microfibers showed a beneficial effect on the physical properties of the grout by increasing the drying shrinkage resistance and decreasing the permeability compared to the reference mix and two commercial dry prepackaged grouts. The optimal grout mix was the one with a percentage of basalt microfibers of 0.10%, which decreased drying shrinkage by 15.98% at 14 days compared to the reference mix, and permeability to chloride ions decreased by 10.82% compared to the control mix.

Case report: Assessment of linguistic, cognitive, and sensory profile competencies in a child with ASD and epilepsy.

Introduction: Autism Spectrum Disorder (ASD) and epilepsy pose significant challenges for early diagnosis during childhood. Current scientific literature does not reflect robust action protocols that allow for a detailed screening of difficulties in this population, especially in areas such as language, cognition, and sensory profile. Additionally, detecting epilepsy before the age of 4 is established as a major current public health challenge in our society. Objective: The aim was to evaluate a patient exhibiting symptoms compatible with both ASD and epilepsy, determining the linguistic, cognitive, and sensory profile through a clinical assessment protocol. Furthermore, the objective included establishing a diagnosis of ASD. Method: This single-case study (N = 1) presents the evaluation of a 7-year-old patient with suspected ASD, experiencing a decline in linguistic and cognitive competencies following a documented epileptic episode. Evaluation was conducted using instruments such as CELF-5, PROLEC-R, WISC-V, ENFEN, PS-2, ADI-R, and ADOS-2. Results: Following assessment of language, cognition, sensory aspects, and behaviors associated with ASD, the diagnosis of ASD was confirmed in the patient, along with impairments in expressive and receptive language, executive functioning, and alterations in the sensory profile. Conclusion: Diagnosing ASD and epilepsy, as well as their evaluation, is a complex process requiring interdisciplinary assessment involving a detailed exploration of all functional competencies in individuals with this comorbidity. Future studies should focus on creating and improving existing protocols to develop optimal and effective evaluation strategies for assessing this population during childhood.

Evaluación de las competencias lingüísticas en una adolescente con síndrome de alcoholismo fetal: Un estudio de un caso / Speech therapy assessment of language skills in a teenager with foetal alcohol syndrome: A case study

El presente estudio de caso presenta la evaluación de una paciente adolescente de 17años, adoptada en los países del Este, con discapacidad intelectual límite y problemas sensoriales. Tras la evaluación inicial se diagnosticó un trastorno del desarrollo del lenguaje de tipo fonológico-sintáctico, con comorbilidad con dislexia evolutiva e importantes problemas sensoriales. Paralelamente al diagnóstico se postuló que la adolescente sufriría síndrome de alcoholismo fetal asociado a la exposición prenatal al alcohol, tanto por su cuadro clínico como por las sospechas de su historial de adopción.(AU)

The present case study presents the speech therapy evaluation of a 17-year-old adolescent patient, adopted in an Eastern country, with borderline intellectual disability and sensory problems. After the initial evaluation, a specific lexical-syntactic language disorder was diagnosed, with comorbidity with evolutionary dyslexia and severe sensorial problems. Parallel to the diagnosis, it was postulated that the adolescent had foetal alcohol syndrome associated with prenatal alcohol exposure, both due to her clinical condition and suspicion from her adoption history. After a year of speech therapy intervention, the girl showed no improvement.(AU)

Validation of the Spanish version of the Childhood Executive Functioning Inventory (CHEXI) in 4-5 year-old children

Contexto:El Childhood Executive Functioning Inventory (CHEXI) se diseñó para detectar déficit de Funciones Ejecutivas (FE) en contextos de la vida diaria.El propósito del presente estudio era validar la versión española del CHEXI para niños de 4 y 5 años. Método:Se obtuvie-ron las valoraciones de los padres y las puntuaciones en test de laboratorio en una muestra de 445 niños de 4 años (196 niñas, 249niños) yotra de 459 niños de 5 años (208 niñas, 251 niños). Un año más tarde se volvieron a re-coger las valoraciones de los padres en CHEXI. Resultados:Se replicó la es-tructura de dos factores de CHEXI(Memoria de Trabajo e Inhibición), ob-teniendo una alta consistencia interna y estabilidad temporal. Los niños de 4 años eran valorados con mayor déficit en FE que los niños de 5 años. Los niños alcanzaban puntuaciones más elevadas de déficit de FE. Sin em-bargo, no aparecieron diferencias significativas de géneroen las pruebas conductuales. Finalmente, se encontró una baja asociación entre las valora-ciones de CHEXI y las puntuaciones de las pruebas conductuales. Este re-sultado sugiere que los inventarios y las medidas conductuales evalúan dife-rentes aspectos de las FE.Conclusiones:La versión española de CHEXI ofrece un instrumento válido para evaluar las FE en niños de 4 y 5 años.(AU)

Background:The Childhood Executive Functioning Inventory (CHEXI) was designed to identify EF deficits in daily life contexts.The aim of the present study was to validate the Spanish version of the CHEXI in 4-5-year-old children.Method: Parents’ ratings of the CHEXI and labora-tory tests of EF were investigated in two large samples of 445 children aged 4 years (196 girls, 249 boys)and 459 children aged 5 years (208 girls, 251 boys). CHEXI ratings were collected again after one-year. Results:The two-factor structure of the CHEXI (i.e., Working Memory and Inhibition) was replicated, showing high internal consistency and temporal stability. The 4-year-olds were reported to have higher EF deficits than 5-year-olds have. Boys were rated as having higher EF deficits than girls were. Howev-er, gender differences were not significant contrasting performance on EF tasks. Finally, associations between CHEXI ratings and EF tests were weak, suggesting that EF tests and EF ratings capture different aspects of EF. Conclusions:The Spanish CHEXI provides a suitable instrument to as-sess EF in 4-5-year-old children.(AU)

Allophonic perception of VOT contrasts in Spanish children with dyslexia.

INTRODUCTION: Previous studies have evidenced a different mode of speech perception in dyslexia, characterized by the use of allophonic rather than phonemic units. People with dyslexia perceive phonemic features (such as voicing) less accurately than typical readers, but they perceive allophonic features (i.e., language-independent differences between speech sounds) more accurately. METHOD: In this study, we investigated the perception of voicing contrasts in a sample of 204 Spanish children with or without dyslexia. Identification and discrimination data were collected for synthetic sounds varying along three different voice onset time (VOT) continua (ba/pa, de/te, and di/ti). Empirical data will be contrasted with a mathematical model of allophonic perception building up from neural oscillations and auditory temporal processing. RESULTS: Children with dyslexia exhibited a general deficit in categorical precision; that is, they discriminated among phonemically contrastive pairs (around 0-ms VOT) less accurately than did chronological age controls, irrespective of the stimulus continuum. Children with dyslexia also exhibited a higher sensitivity in the discrimination of allophonic features (around ±30-ms VOT), but only for the stimulus continuum that was based on a nonlexical contrast (ba/pa). CONCLUSION: Fitting the neural network model to the data collected for this continuum suggests that allophonic perception is due to a deficit in "subharmonic coupling" between high-frequency oscillations. Relationships with "temporal sampling framework" theory are discussed.

Corrosion Behavior of Steel-Reinforced Green Concrete Containing Recycled Coarse Aggregate Additions in Sulfate Media.

Novel green concrete (GC) admixtures containing 50% and 100% recycled coarse aggregate (RCA) were manufactured according to the ACI 211.1 standard. The GC samples were reinforced with AISI 1080 carbon steel and AISI 304 stainless steel. Concrete samples were exposed to 3.5 wt.% Na2SO4 and control (DI-water) solutions. Electrochemical testing was assessed by corrosion potential (Ecorr) according to the ASTM C-876-15 standard and a linear polarization resistance (LPR) technique following ASTM G59-14. The compressive strength of the fully substituted GC decreased 51.5% compared to the control sample. Improved corrosion behavior was found for the specimens reinforced with AISI 304 SS; the corrosion current density (icorr) values of the fully substituted GC were found to be 0.01894 µA/cm2 after Day 364, a value associated with negligible corrosion. The 50% RCA specimen shows good corrosion behavior as well as a reduction in environmental impact. Although having lower mechanical properties, a less dense concrete matrix and high permeability, RCA green concrete presents an improved corrosion behavior thus being a promising approach to the higher pollutant conventional aggregates.

Linfoma no Hodgkin tipo MALT de la glándula parótida. Presentación de un caso / MALT non-Hodgkin Lymphoma of the Parotid Gland. Presentation of a Case

Resumen Los linfomas de las glándulas salivales son una entidad e incidencia rara. La localización más frecuente es la glándula parótida, seguida de las glándulas submandibular y sublingual. La mayoría de los linfomas parótidos son linfomas no Hodgkin y se consideran derivados de tejido linfoide asociado a la mucosa (MALT). De manera poco frecuente, estos casos se han notificado y con frecuencia se diagnostican de manera inadecuada, ya que su presentación es relativamente benigna, comportamiento localizado, crecimiento lento y varios años de evolución.

Abstract Lymphomas of the salivary glands are a rare entity with a rare incidence. They are more commonly found on the parotid gland, followed by the submandibular and sublingual glands. The majority of parotid lymphomas are non-Hodgkin's lymphomas and are considered to be derived from mucosal-associated lymphoid tissue (MALT). Reports of these cases are scarce and often misdiagnosed since: their manifestation is relatively benign, they have a localized behavior, a slow growth and the evolution takes several years.

Corrosion Behavior of AISI 304 Stainless Steel Reinforcements in SCBA-SF Ternary Ecological Concrete Exposed to MgSO4.

In this study, ternary ecological concrete (TEC) mixtures were produced with partial substitution of the ordinary Portland cement (OPC) by 10%, 20%, and 30% of sugar cane bagasse ash (SCBA) and silica fume (SF); a control mixture (100% OPC) was prepared according to ACI 211.1 standard. The studied TEC specimens were reinforced with AISI 304 stainless steel and AISI 1018 carbon steel rebars. TEC reinforced specimens were immersed in two different electrolytes, a control (DI-water) and 3.5 wt.% MgSO4 solution, for 180 days. The electrochemical corrosion was monitored by corrosion potential (Ecorr) according to ASTM C-876-15 standard, and the linear polarization resistance (LPR) technique using ASTM G59 standard. The Ecorr and current density icorr results show that AISI 304 stainless steel rebars have a high corrosion resistance, with icorr values below 0.1 µA/cm2, which is interpreted as a level of negligible corrosion. The best corrosion performance was found for the TEC mixture made with a 20% addition of blend of sugar cane bagasse ash-silica fume (SCBA-SF) to the OPC.

EEG Connectivity Analysis Using Denoising Autoencoders for the Detection of Dyslexia.

The Temporal Sampling Framework (TSF) theorizes that the characteristic phonological difficulties of dyslexia are caused by an atypical oscillatory sampling at one or more temporal rates. The LEEDUCA study conducted a series of Electroencephalography (EEG) experiments on children listening to amplitude modulated (AM) noise with slow-rythmic prosodic (0.5-1[Formula: see text]Hz), syllabic (4-8[Formula: see text]Hz) or the phoneme (12-40[Formula: see text]Hz) rates, aimed at detecting differences in perception of oscillatory sampling that could be associated with dyslexia. The purpose of this work is to check whether these differences exist and how they are related to children's performance in different language and cognitive tasks commonly used to detect dyslexia. To this purpose, temporal and spectral inter-channel EEG connectivity was estimated, and a denoising autoencoder (DAE) was trained to learn a low-dimensional representation of the connectivity matrices. This representation was studied via correlation and classification analysis, which revealed ability in detecting dyslexic subjects with an accuracy higher than 0.8, and balanced accuracy around 0.7. Some features of the DAE representation were significantly correlated ([Formula: see text]) with children's performance in language and cognitive tasks of the phonological hypothesis category such as phonological awareness and rapid symbolic naming, as well as reading efficiency and reading comprehension. Finally, a deeper analysis of the adjacency matrix revealed a reduced bilateral connection between electrodes of the temporal lobe (roughly the primary auditory cortex) in DD subjects, as well as an increased connectivity of the F7 electrode, placed roughly on Broca's area. These results pave the way for a complementary assessment of dyslexia using more objective methodologies such as EEG.

Infusión de furosemida intravenosa domiciliaria, continua y prolongada en insuficiencia cardiaca refractaria por pericarditis constrictive / Long-term home-administered continuous intravenous furosemide infusion in refractory heart failure from constrictive pericarditis

Presentamos dos casos clínicos de pacientes con pericarditis constrictiva en insuficiencia cardiaca refractaria a tratamiento diurético combinado y dosis elevadas de furosemida, con disnea de pequeños-mínimos esfuerzos y grandes dificultades para abandonar el hospital por dependencia al tratamiento parenteral. Fueron tratados con infusión continua intravenosa de furosemida mediante infusores elastoméricos. La técnica se mantuvo a largo plazo en domicilio de forma eficaz, con muy buena tolerancia y sin efectos secundarios reseñables

We present two clinical cases about constrictive pericarditis in advanced heart failure refractory to combined diuretic therapy and high dose of furosemide. Patients had small-minimum efforts dyspnea and difficulties to be discharged because of parenteral treatment dependency. They were treated with intravenous continuous furosemide infusion administered by elastomeric pumps. Long-term use at home was effective, well-tolerated and without remarkable secondary effect

Perfusión de furosemida subcutánea como tratamiento paliativo en insuficiencia cardiaca refractaria / Subcutaneous furosemide infusion as palliative treatment in refractory end-stage heart failure

Resumen En la insuficiencia cardiaca terminal los síntomas predominantes habitualmente están relacionados con la congestión; sin embargo, la resistencia a diuréticos vía oral es frecuente y necesita tratamiento parenteral para paliar los síntomas. La administración intravenosa de furosemida requiere hospitalización o asistencia hospitalaria, lo que supone un deterioro significativo de la calidad de vida de pacientes en fases avanzadas de la enfermedad. La administración subcutánea continua de furosemida mediante infusor elastomérico es una técnica eficaz con baja tasa de complicaciones graves que permite la administración de diurético parenteral en el ámbito domiciliario, y evita la necesidad de hospitalizar. A pesar de que esta modalidad de tratamiento no está aceptada en ficha técnica y requiere más estudios que precisen su indicación, puede suponer un recurso adecuado para pacientes seleccionados. Se presenta el caso de una paciente con insuficiencia cardiaca avanzada, síntomas congestivos y ausencia de respuesta a tratamiento deplectivo vía oral, tratada con perfusión continua subcutánea domiciliaria de furosemida mediante infusor elastomérico de forma prolongada.

Abstract In end-stage heart failure the predominant symptoms are usually associated with congestion. However, the resistance to oral diuretics is common and requires parenteral treatment to alleviate the symptoms. The intravenous administration of furosemide requires hospital admission or hospital care. This leads to a significant decrease in the quality of life of patients in advance stages of the disease. The continuous subcutaneous infusion of furosemide using an elastomeric pump is an effective technique, with a low rate of serious complications that allows a parenteral diuretic to be administered in the home environment and thus avoiding the need for hospital admission. Despite this mode of treatment not being indicated in the drug data sheet, and requires more studies that specify its indication, it may be a suitable recourse for selected patients. It is presented a case of a patient with advanced heart failure, congestive symptoms, and a lack of response to oral diuretics treatment, and then treated with a continuous and prolonged subcutaneous infusion of furosemide at home using an elastomeric infusion pump.