Alteraciones tiroideas: ¿Predictores de mortalidad en Cuidados Intensivos? / Thyroid disorders: Predictors of mortality in Intensive Care?

Introducción: El objetivo del estudio es describir y analizar la función tiroidea en el paciente crítico. Describir si algún patrón se asocia a una mayor tasa de mortalidad. Métodos: Se analizó a todos los pacientes ingresados en nuestra Unidad de Cuidados Intensivos, entre enero de 2015 y agosto de 2016, y que permanecieron allí, al menos, siete días. Resultados: Se incluyeron 242 pacientes. Se hallaron diferencias significativas en los valores medios de los índices de gravedad entre los no supervivientes y los supervivientes: SOFA (10,45 vs. 7,9); APACHE II (24,42 vs. 20,71); SAPS II (63,14 vs. 50,69). Se encontraron diferencias estadísticamente significativas en los valores medios de T3 en el grupo de supervivientes y no supervivientes: 1,5 pg/ml vs. 1,15 pg/ml (p <0,001; IC95% 0,224 ± 0,487). No hubo diferencias estadísticamente significativas en los valores medios de T4 y TSH. Al realizar el subanálisis según grupo de ingreso, no se hallaron diferencias estadísticamente significativas entre las cifras de TSH, T3 o T4. Sí hubo diferencias significativas en los valores medios de T3 en la mayor parte de los subgrupos. Conclusiones: Se hallaron diferencias estadísticamente significativas entre los valores medios de T3 en el grupo de supervivientes y no supervivientes. Los valores de T3 parecen asociarse a la mortalidad. Su descenso no parece asociarse a la enfermedad subyacente, sino a su gravedad.(AU)

Introduction: The aim of this study is to describe and analyse the thyroid function in the critically ill patient, and to describe if any pattern is associated with a higher mortality rate. Methods: Patients admitted to the Intensive Care Unit, between January 2015 and August 2016, with a stay of seven days or more, were enrolled. Results: Two hundred and forty-two patients were included. Significant differences were observed in the severity scores related to mortality during their stay in the Intensive Care Unit (no survivors vs. survivors): SOFA (10.45 vs. 7.9); APACHE II (24.42 vs. 20.71); SAPS II (63.14 vs. 50.69). Statistically significant differences were observed in the mean values of T3 between survivors and non-survivors: 1.5 pg/ml vs. 1.15 pg/ml (p <0.001; CI95% 0.224 ± 0.487). There were no statistically significant differences in the mean values of T4 and TSH. After subgroup analysis according to the admission group, no significant differences among the TSH, T3 and T4 values were detected. However a statistically difference in T3 average value was found in most subgroups. Conclusions: A statistically significant difference was found in mean T3 values in survivors and non-survivors. T3 concentration appears to be associated with mortality. Decrease of this thyroid hormone does not seem to associate with the underlying disease, but with its severity.(AU)

Cysteine and cysteine-related signaling pathways in Arabidopsis thaliana.

Cysteine occupies a central position in plant metabolism because it is a reduced sulfur donor molecule involved in the synthesis of essential biomolecules and defense compounds. Moreover, cysteine per se and its derivative molecules play roles in the redox signaling of processes occurring in various cellular compartments. Cysteine is synthesized during the sulfate assimilation pathway via the incorporation of sulfide to O-acetylserine, catalyzed by O-acetylserine(thiol)lyase (OASTL). Plant cells contain OASTLs in the mitochondria, chloroplasts, and cytosol, resulting in a complex array of isoforms and subcellular cysteine pools. In recent years, significant progress has been made in Arabidopsis, in determining the specific roles of the OASTLs and the metabolites produced by them. Thus, the discovery of novel enzymatic activities of the less-abundant, like DES1 with L-cysteine desulfhydrase activity and SCS with S-sulfocysteine synthase activity, has provided new perspectives on their roles, besides their metabolic functions. Thereby, the research has been demonstrated that cytosolic sulfide and chloroplastic S-sulfocysteine act as signaling molecules regulating autophagy and protecting the photosystems, respectively. In the cytosol, cysteine plays an essential role in plant immunity; in the mitochondria, this molecule plays a central role in the detoxification of cyanide, which is essential for root hair development and plant responses to pathogens.

Psychoeducative groups help control type 2 diabetes in a primary care setting / La terapia psicoeducativa grupal en atención primaria ayuda en el control de la diabetes tipo 2

Introduction: The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c), the body mass index (BMI) and cardiovascular risk factors (CVRF) compared with conventional educational measures provided individually. Methods: A quasi-experimental study (pre/post-intervention) with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m2). The beneficial effect of psychoeducational group therapy in the study group (PGT) was compared with conventional diabetes education in the control group (CG). Results: The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003), met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005) and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002) than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05). Conclusions: PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care (AU)

Introducción: Los cambios en el estilo de vida mejoran el control de los diabéticos tipo 2, pero no sabemos cuales son las estrategias más eficientes para conseguir estos cambios. Hemos medido el impacto de una intervención psicoeducativa grupal en diabetes mediante hemoglobina glicosilada (HbA1c), índice de masa corporal (IMC) y factores de riesgo cardiovascular (FRCV). Métodos: Se trata de un ensayo clínico controlado, randomizado y multicéntrico, de 72 pacientes diabéticos tipo 2, edad media 63,08 años, 50% mujeres, HbA1c media 6.98% e IMC medio 30,48 kg/m2. Se comparó el efecto terapéutico de una intervención psicoeducativa grupal (GSE) con una educación diabetológica convencional (GC).Resultados: El GSE presentó una mayor reducción media de HbA1c, -0,51 ± 1,07 vs -0,06 ± 0,53% (p 0,003), un mayor grado de cumplimiento de los objetivos de control óptimo de HbA1c, 80% vs 48% (p 0,005) y una mayor reducción media de peso, -1,93 ± 3,57 vs 0,52 ± 1,73 kg (p 0,002), que el GC. También se objetivó una mejoría significativa de colesterol total, colesterol LDL, triglicéridos, tensión arterial sistólica y diastólica en GSE (todas las p < 0,05). Conclusiones: Los GSE de diabéticos tipo 2 consiguieron una mejoría significativa de HbA1c, IMC y FRCV, y superaron a la educación diabetológica convencional en el grado de cumplimiento de los objetivos de control óptimo de la diabetes. Debemos plantearnos cambios estructurales en nuestros programas asistenciales para introducir estos avances más eficientes en educación terapeútica de diabetes en atención primaria (AU)

Tratamiento de las fracturas de meseta tibial mediante reducción abierta y fijación interna / Treatment of tibial plateau fractures by open reduction and internal fixation

Objetivo. Describir los resultados funcionales obtenidos tras el tratamiento quirúrgico mediante reducción abierta y fijación interna de las fracturas de meseta tibial. Material y método. Se revisaron de forma retrospectiva 48 casos de fractura de meseta tibial tratadas mediante reducción abierta y fijación interna en el período comprendido entre los años 1991-1995. Se recogieron y analizaron las variables epidemiológicas, complicaciones pre y posquirúrgicas y la técnica de síntesis empleada. La clasificación de las fracturas se realizó según la sistemática de Schatzker y la de AO. Resultados. Los resultados globales obtenidos a través de la Knee Score de Insall fueron excelentes en 28 pacientes, buenos en 9, regulares en 8 y malos en 3. El factor determinante en los resultados funcionales fue la edad en el momento de la fractura, teniendo menos importancia el tipo de fractura o el uso de injerto óseo (AU)

Nefropatía lúpica en hombres / Lupus Nephropathy in men

El lupus eritematoso aistémico (LES) es una enfermedad multisistémica, de etiología desconocida,caracterizada por la producción de anticuerpos, que se presenten en huéspedes susceptibles, en loscuales probablemente exista una alteración en la homeostasis de los linfocitos y la tolerancia periféricaasociada a un proceso apoptoico incrementado y con defectos en la remoción de los autoantígenosgenerados.Aunque el LES es más frecuente en mujeres que en hombres, es importante no olvidar que en estosúltimos es mucho más severo cuando se presenta, por lo que la morbimortalidad es mucho más elevada.Los tratamientos actuales con corticoides e inmunosupresores consiguen un control de la enfermedaden un 70 – 80 por ciento de los casos, pero a expensas de una alta morbilidad.

Systemic Lupus Erithematosus (LES) it is a multisystemic disease of unknown etiology, characterizedby the production of antibodies that present in susceptible hosts, in whom the probably exists analteration in lymphocytes homeostasis, and the tolerance associated to an increased apoptotic processcorrelated to a defect in the removal of the auto - antigens generated.Although it is more frequent in women rather than men, it is important not to forget that in men itis apperance is more severe, which is why themorbi - mortality is higher. Current treatments withcorticoids and inmunosupresores achieve disease control in 70 - 80 percent of cases, but based on a highmorbility.Case Nº one is about a 19 year old patient with a LES diagnosis of more or less 3 years, whose firstmanifestations of the disease were generalized arthalgias, anemia, widespread edema with changes inrenal function and reactivation of the clinicalmanifestations, such as convulsive crisis and high bloodpressure.Case Nº two corresponds to a 32 year old male with a 5 years diagnostic status of LES with irregulartreatment regimen, who has reactivation of this clinical symptoms with generalized edema, skin rashand generalized convulsive..

Should the cell saver autotransfusion system be routinely used in elective aortic surgery?

The objective of this study is to identify the aortic surgery procedures in which the use of the Cell Saver autotransfusion system is beneficial in terms of the amount of autologous blood recovered and the reduction in blood bank demands. An evaluation of the cost-effectiveness of the system is also presented. Four hundred and thirty-four elective aortic interventions were retrospectively reviewed to examine the use of intraoperative autotransfusion (IAT). Evaluation was made of risk factors, preoperative hematological variables, the volume of IAT-processed reinfused blood, and homologous transfusion requirements over the period of hospitalization. The routine use of the IAT system was cost-effective in the interventions for AAA and TAA. In patients subjected to aortobifemoral bypass for aortoiliac occlusive disease, IAT served to alleviate demands on blood bank inventories, although in our center its use led to a slight increase in net cost. The routine use of IAT during unilateral revascularization due to occlusive disease offered no benefits in terms of reduced homologous transfusion requirements or cost-effectiveness.

[Health education: repercussions of a self-help program on the psychological status of perimenopausal women]. / Educación para la salud: repercusión de un programa de autoayuda en el estado psíquico de mujeres perimenopáusicas.

OBJECTIVE: To establish the effect caused by a self-help programme for climacteric and menopause on the psychological state of women of menopausal age. DESIGN: A semi-experimental study with a comparison group. SETTING: Primary Care. PARTICIPANTS: 106 women between 45 and 60, users of Albacete's Area IV Health Centre, of whom 53 were in the intervention group and the other 53 in the control group. Intervention. This consisted of developing an educational programme on the changes occurring in middle-aged women (biological, psychological and social), which included exercises in body movement, relaxation and group discussions. The intervention, aimed at groups of 8 to 10 women, was performed by 4 female nurses in 10 weekly hour-long sessions. MEASUREMENTS AND RESULTS: The participants were interviewed and information was gathered on their functional ability, medicine consumption, frequency of attendance, and their social and demographic data. Their psychological well-being was assessed through the Goldberg Health questionnaire before and after the intervention. At the start, 62 women (70.5%) presented a probable mental disorder, with no statistically significant difference between the two groups. Circumstances such as lower social class, having family members to look after, greater use of consultations, greater consumption of medicines and more functional disability were linked to a higher prevalence of psychological malaise. After the intervention, 82.5% of the women in the control group had probable psychological disorders, but only 8.3% of those in the intervention group. The difference was statistically highly significant (P < 0.00001; RR = 9.9; 95% Cl, 3.8-25.3). CONCLUSIONS: Self-help programmes have a favourable impact on the psychological state of menopausal women. They may be particularly justified when there are circumstances linked to greater prevalence of mental disorders. The results show that educational programmes are very useful in the Primary Care setting.

Arteriovenous fistula as a complication of lumbar disc surgery: case report.

Arteriovenous fistula (AVF) is a rare, late complication of lumbar disc surgery. It is often not suspected and the symptoms are diagnosed as heart failure or deep venous thrombosis. We report a case in which the patient developed leg swelling and high-output congestive heart failure due to a left ilioiliac AVF after lumbar laminectomy.

[Carotid endarterectomy using cervical plexus block]. / Endarterectomía carotídea mediante bloqueo del plexo cervical.

To evaluate the efficacy and level of patient satisfaction, as well as the incidence of neurological manifestations, hemodynamic changes and other perioperative complications of cervical plexus block. This was a prospective study of 52 patients undergoing carotid endarterectomy under superficial and deep cervical plexus block. The anesthetic technique was effective in all cases. Supplementation with local anesthetic was needed for 25% of the patients and none required general anesthesia. The technique was considered good by 92% of the patients, who stated that would accept the same technique in case of having to undergo surgery on the contralateral carotid artery. Hypertension was the hemodynamic change observed most often (in 30%) during surgery. No serious complications related to the anesthetic technique were observed, though transient dysphonia was the most frequently seen effect (in 36.5%). Eight (15.4%) patients showed neurological signs when the carotid was clamped, with symptoms resolving with placement of a shunt. Two deaths due to myocardial infarction occurred after surgery and 1 patient suffered a permanent cerebrovascular accident. Regional anesthesia with deep and superficial cervical plexus block during carotid endarterectomy allows for continuous evaluation of the patient's neurological status and facilitates the selective use of intraluminal shunt for the prevention of stroke accident during surgery. The technique is well-tolerated by patients, does not make surgery more difficult, does not give rise to serious complications and the incidence of local complications is low.

[Surgery for the repair of renal arteriovenous fistula and its hemodynamic impact]. / Cirugía de reparación de una fístula arteriovenosa renal y su repercusión hemodinámica.

The case of a 42-year-old woman with an arteriovenous fistula on the left kidney is described. Twenty-six years before presentation, a percutaneous renal biopsy had been obtained. The patient presented with arterial hypertension, angina and dyspnea. We studied the hemodynamic parameters before and after surgical repair of the fistula. Pulmonary artery pressure was very high but fell to normal after surgery, indicating that the fistula was responsible for hemodynamic complications that increased the level of surgical risk.

[Color-coded Doppler in the diagnosis of vascular complications following heart catheterization]. / Doppler codificado en color en el diagnóstico de las complicaciones vasculares tras el cateterismo cardíaco.

To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.

Iliac arteriovenous fistula as a complication of lumbar disc surgery. Report of two cases and review of literature.

Vascular lesions following surgery of the lumbar disc are very infrequent, and exceptionally an arteriovenous fistula can developed. An important proportion of the reported cases were previously diagnosed as deep venous thrombosis, because this kind of pathology was not suspected. Postsurgical arteriovenous fistula produces severe haemodynamic disturbances, and congestive heart failure will develop if they are left to their natural course without intervention. Arteriovenous fistula should be suspected in the post-operative period of the lumbar disc surgery if congestive heart failure appears, accompanied by swelling of one or both lower limbs. Early surgery is the treatment of choice in order to prevent the congestive heart failure, and to preserve the normal function of the lower extremities. The technical choice seems to be the closure of the orifice of the fistula through the arterial lumen, together with appropriate arterial reconstruction.