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INTRODUCTION: The use of abdominal radiography (AXR) apparently continues to be widespread despite its limited indications, the potential radiation and unnecessary costs associated. In addition, the interpretation and its report seem variable and not always performed by a radiologist. Our objective is to analyze the use, adequacy and usefulness of AXR in the emergency of a tertiary referral hospital. MATERIAL AND METHODS: We retrospectively reviewed all the AXR performed in January 2020 in the emergency of our centre, as well as the patient's demographics and medical records, technical quality of the radiographs, indications according to the SERAM (Spanish Society of Radiology) Appropriateness Guidelines, presence of a formal radiology report, and impact on the clinical management of the patient. Of all non-appropriated AXR we calculated the radiation received by the patients and its extra costs. RESULTS: In January 2020, 429 AXR (9.1% of all radiographies) were performed in the emergency of our centre. The most frequent indication was abdominal pain (40%, nâ¯=â¯176), followed by low back pain (21.4%, nâ¯=â¯92). 12.4% of AXR requested did not include any clinical information. Most of the AXR (79.6%) had sufficient technical quality. 61.3% (nâ¯=â¯263) of the AXR performed were not indicated, assuming an average unjustified radiation dose per patient of 0.50⯱â¯0.33â¯mSv, and a total additional cost of 6575;. Only 6% of the inadequate AXRs led to a change in the clinical management of the patient, compared to 29% of the adequate AXR (pâ¯<â¯0.001). Only 3% of the AXR had a formal radiology report. CONCLUSIONS: AXR is still common in the emergency setting, although most of them might be inadequate according to the SERAM Appropriateness Guidelines. Its use should be optimized to avoid unnecessary radiation and costs. Radiologists must have a more active participation in the management of AXR.
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Serviço Hospitalar de Emergência , Radiografia Abdominal , Humanos , Estudos Retrospectivos , Serviço Hospitalar de Emergência/economia , Radiografia Abdominal/economia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Proteção Radiológica/economia , Idoso , Idoso de 80 Anos ou mais , Utilização de Procedimentos e Técnicas , Adolescente , Adulto JovemRESUMO
RATIONALE: End-expiratory lung volume (EELV) is reduced in mechanically ventilated patients, especially in pathologic conditions. The resulting heterogeneous distribution of ventilation increases the risk for ventilation induced lung injury. Clinical measurement of EELV however, remains difficult. OBJECTIVE: Validation of a novel continuous capnodynamic method based on expired carbon dioxide (CO2) kinetics for measuring EELV in mechanically ventilated critically-ill patients. METHODS: Prospective study of mechanically ventilated patients scheduled for a diagnostic computed tomography exploration. Comparisons were made between absolute and corrected EELVCO2 values, the latter accounting for the amount of CO2 dissolved in lung tissue, with the reference EELV measured by computed tomography (EELVCT). Uncorrected and corrected EELVCO2 was compared with total CT volume (density compartments between - 1000 and 0 Hounsfield units (HU) and functional CT volume, including density compartments of - 1000 to - 200HU eliminating regions of increased shunt. We used comparative statistics including correlations and measurement of accuracy and precision by the Bland Altman method. MEASUREMENTS AND MAIN RESULTS: Of the 46 patients included in the final analysis, 25 had a diagnosis of ARDS (24 of which COVID-19). Both EELVCT and EELVCO2 were significantly reduced (39 and 40% respectively) when compared with theoretical values of functional residual capacity (p < 0.0001). Uncorrected EELVCO2 tended to overestimate EELVCT with a correlation r2 0.58; Bias - 285 and limits of agreement (LoA) (+ 513 to - 1083; 95% CI) ml. Agreement improved for the corrected EELVCO2 to a Bias of - 23 and LoA of (+ 763 to - 716; 95% CI) ml. The best agreement of the method was obtained by comparison of corrected EELVCO2 with functional EELVCT with a r2 of 0.59; Bias - 2.75 (+ 755 to - 761; 95% CI) ml. We did not observe major differences in the performance of the method between ARDS (most of them COVID related) and non-ARDS patients. CONCLUSION: In this first validation in critically ill patients, the capnodynamic method provided good estimates of both total and functional EELV. Bias improved after correcting EELVCO2 for extra-alveolar CO2 content when compared with CT estimated volume. If confirmed in further validations EELVCO2 may become an attractive monitoring option for continuously monitor EELV in critically ill mechanically ventilated patients. TRIAL REGISTRATION: clinicaltrials.gov (NCT04045262).
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Capnografia , Estado Terminal , Medidas de Volume Pulmonar , Humanos , Masculino , Feminino , Estado Terminal/terapia , Estudos Prospectivos , Pessoa de Meia-Idade , Idoso , Medidas de Volume Pulmonar/métodos , Capnografia/métodos , Respiração Artificial/métodos , COVID-19 , Tomografia Computadorizada por Raios X/métodos , AdultoRESUMO
There are currently several commercialized products approved by the Food and Drug Administration and the European Medicines Agency based on the use of recombinant human BMP-2 for the treatment of non-unions long fractures and spinal fusion. However, the adverse effects recorded with the use of BMPs suggest the need for drug delivery carriers that allow reducing the required doses and improve their cost-effectiveness. Herein, we have developed a new osteoconductive scaffold that reduces the required doses of BMP-2 for promoting bone regeneration in an osteoporotic defect model. The composite is, in brief, a gelatin-based 3D scaffold reinforced with either calcium sulfate or hydroxyapatite as an inorganic osteoconductive biomaterial. To this end, the organic/inorganic composite systems showed high hydration capacity and good in vitro degradability. The incorporation of 7.5% (m/v) ceramic compounds resulted in scaffolds with stiffer Young modulus (179 and 75 kPa for CaSO4_7 and HA_7, respectively) than bare gelatin hydrogels (48 kPa). Studies with human bone-marrow derived mesenchymal stem cells (hBM-MSCs) revealed that the 3D scaffolds promote cell adhesion and proliferation along with osteogenic differentiation capabilities. Specifically, downregulation of stemness (Nanog, Oct4) genes and upregulation of osteogenic markers (ALP, Col1a1, Fmod) by two fold were observed over 10 days under basal culture conditions. Promisingly, the sustained in vitro release of BMP-2 observed from the porous reinforced scaffolds allowed us to address the critical-sized osteoporotic mice calvarial defects with a relatively low growth factor doses (600 ng BMP-2/scaffold) compared to conventional doses at 2-15 micrograms. Overall, this study demonstrates the promising potential of osteoconductive gelatin/calcium bioceramics composites as osteogenic growth factors delivery carriers for bone-regeneration via ultra-low growth factor doses.
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Proteína Morfogenética Óssea 2 , Portadores de Fármacos , Osteogênese , Osteoporose , Animais , Proteína Morfogenética Óssea 2/farmacologia , Cerâmica/química , Portadores de Fármacos/química , Gelatina/química , Humanos , Camundongos , Osteoporose/tratamento farmacológico , Alicerces TeciduaisRESUMO
Resumen Introducción: La dependencia al alcohol, considerada como una enfermedad crónica, es un detonante de incertidumbre para el familiar de la persona con dependencia, lo cual genera trastornos emocionales negativos. El apoyo social y la espiritualidad son mecanismos de afrontamiento que podrían disminuir la incertidumbre y favorecer el bienestar tanto físico, como psicológico. Objetivos: Determinar la relación y el efecto del apoyo social y la espiritualidad sobre la incertidumbre del familiar de la persona dependiente del alcohol. Métodos: Estudio descriptivo y correlacional, muestra de 135 mujeres pertenecientes a grupos Al-Anon, se utilizaron la Escala de Percepción de Incertidumbre en Padres y Miembros de la Familia (PPUS-FM) de Mishel, el cuestionario MOS-SSS de Sherbourne y Stewart y la Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Se identificó un coeficiente de correlación negativo y significativo de la incertidumbre con el apoyo social (r s= -.356, p <.01) y la espiritualidad (r s= -.216, p <.05). Mediante un modelo de regresión lineal general univariado se determinó que únicamente el apoyo social influye en la disminución de la incertidumbre (β= -.280, t= -3.62, p= .001) con un coeficiente de determinación o varianza explicada del 11.5%, mientras que la espiritualidad no mostró efecto (β= -.041, t= .218, p >.05) sobre la incertidumbre. Conclusiones: El apoyo social es identificado como un mecanismo de afrontamiento efectivo que permitirá al personal de enfermería desarrollar intervenciones dirigidas a reducir la incertidumbre en familiares de personas con algún tipo de dependencia.
Abstract Introduction: Alcohol dependency is a chronic illness which generates uncertainty and other emotional problems among the relatives of persons who suffer alcoholism. Social support and spirituality are some coping mechanisms which could reduce uncertainty and favor the physical and psychological wellbeing. Objective: To determine the relationship and the effect of social support and spirituality on the uncertainty experienced by relatives of alcohol dependent persons. Methods: This is a descriptive and correlational study. The sample was constituted by 135 women members of Al-Anon. The Mishel Scale of Perception of Uncertainty among Parents and Family Members (PPUS-FM), the Sherbourne and Stewart Questionnaire, and the Reed Spiritual Perspective Scale were all used. Results: Significant negative correlation coefficients between uncertainty and social support (r s= -.356, p .05). and spirituality (r s= -.216, p .05). were identified. Using a univariate general linear regression model, it was determined that only social supports reduced uncertainty (β= -.280, t= -3.62, p= .001) with 11.5% of variance explained; while spirituality did not produce any effect (β = -.041, t= .218, p >.05). Conclusions: Social support is identified as a coping mechanism which can be used by nursing staff to develop interventions aimed at reducing uncertainty among relatives of alcohol dependent persons.
Resumo Introdução: A dependência do álcool, considerada como uma doença crónica, é um gatilho de incerteza para o familiar da pessoa com dependência, o qual gera transtornos emocionais negativos. O suporte social e a espiritualidade são mecanismos de enfrentamento que poderiam diminuir a incerteza e favorecer o bem-estar tanto físico, quanto psicológico. Objetivos: Determinar a relação e o efeito do suporte social e a espiritualidade sobre a incerteza do familiar da pessoa dependente de álcool. Métodos: Estudo descritivo e correlacional, amostra de 135 mulheres pertencentes aos grupos Al-Anon, utilizaram-se a Escala de Percepção de Incerteza em Pais e Membros da Família (PPUS-FM) de Mishel, o questionário MOS-SSS de Sherbourne e Stewart e a Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Identificou-se um coeficiente de correlação negativo e significativo da incerteza com o apoio social (r s= -.356, p <.01) e a espiritualidade (r s= -.216, p <.05). Mediante um modelo de regressão linear geral univariado determinou-se que unicamente o apoio social influencia a diminuição da incerteza (β= -.280, t= -3.62, p= .001) com um coeficiente de determinação ou variância explicada do 11.5%, enquanto a espiritualidade não mostrou efeito (β= -.041, t= .218, p >.05) sobre a incerteza. Conclusões: O suporte social é identificado como um mecanismo de enfrentamento eficaz que permitirá ao pessoal de enfermagem desenvolver intervenções dirigidas a reduzir a incerteza em familiares de pessoas com algum tipo de dependência.
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No disponible
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Humanos , Masculino , Idoso , Bloqueio Atrioventricular/diagnóstico , Eletrocardiografia/métodos , Exercício Físico/psicologiaRESUMO
The plasma cell dyscrasias (PCDs) include a number of entities such as multiple myeloma, primary amyloidosis, and monoclonal immunoglobulin deposition disease. Hematopoietic cell transplant (HCT) is the only cure for a variety of hematologic and oncologic diseases. Clinically significant renal impairment is a common feature in plasma cell myeloma, affecting 20% to 55% of patients at initial diagnosis; 2% to 3% of patients present with failure sufficiently severe to require hemodialysis. This circumstance is associated with a high early mortality. The necessity for immunosuppression after HCT could complicate its management and may precipitate the development of complications. In some patients an effective alternative could be kidney transplant (KT); however, the presence of 2 transplants will require optimal adjustment of immunosuppression and management of complications. At present, there are few published cases of KT after HCT, and the experience of managing 2 transplants is limited. We would like to describe our experience with 4 patients who had a PCD and initially received HCT and received subsequent KT. In our experience the progress and outcome of KT after HCT were optimal. We would like to address that a higher incidence of cytopenia associated with the combination of immunosuppression (lenalidomide, tacrolimus, mycophenolate, etc.) and other drugs (ie, valganciclovir) should be considered together with an increased risk of opportunistic infections and PCD relapse.
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Transplante de Células-Tronco Hematopoéticas , Transplante de Rim , Paraproteinemias/complicações , Paraproteinemias/cirurgia , Insuficiência Renal/cirurgia , Adulto , Idoso , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/etiologiaRESUMO
Objetivos. Averiguar la correlación entre la presión arterial de oxígeno (PaO2) y la saturación de la oxihemoglobina por pulsioximetría (SpO2) en pacientes que acuden a Urgencias con sospecha de insuficiencia respiratoria aguda. Material y métodos. Estudio prospectivo, observacional y multicéntrico realizado en los servicios de Urgencias de 3 hospitales españoles. Resultados. Se incluyeron 166 pacientes, que presentaron unos valores medios±desviación estándar de PaO2, SpO2 y fracción inspiratoria de O2 (FiO2) de 61,64±17,3mmHg, 87,61±8,8% y 0,28±0,15%, respectivamente. La mediana de los cocientes PaO2/FiO2 y SpO2/FiO2 fue de 256,6 y 359,2, respectivamente. La correlación entre la PaO2/FiO2 y la SpO2/FiO2 fue de 0,745 (p<0,001). Conclusiones. La SpO2/FiO2 se puede utilizar como estimación de la PaO2/FiO2 y conocer el estado de oxigenación del paciente con insuficiencia respiratoria aguda (AU)
Objectives. To ascertain the correlation between the partial pressure of oxygen (PaO2) and oxyhaemoglobin saturation by pulse oximetry (SpO2) in patients who were admitted to the emergency department with suspected acute respiratory failure. Material and methods. A prospective, observational multicentre study was conducted in the emergency departments of 3 Spanish hospitals. Results. The study included 166 patients who presented mean±standard deviation PaO2, SpO2 and fraction of inspired oxygen (FiO2) values of 61.64±17.3mmHg, 87.61±8.8% and 0.28±0.15%, respectively. The median PaO2/FiO2 and SpO2/FiO2 ratios were 256.6 and 359.2, respectively. The correlation between PaO2/FiO2 and the SpO2/FiO2 was 0.745 (P<.001). Conclusions. The SpO2/FiO2 ratio can be used to calculate PaO2/FiO2 and determine the oxygenation state of patients with acute respiratory failure (AU)
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Humanos , Oxiemoglobinas/análise , Oximetria/métodos , Insuficiência Respiratória/fisiopatologia , Gasometria/métodos , Doença Aguda , Estudos Prospectivos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Testes de Função Respiratória/métodosRESUMO
OBJECTIVES: To ascertain the correlation between the partial pressure of oxygen (PaO2) and oxyhaemoglobin saturation by pulse oximetry (SpO2) in patients who were admitted to the emergency department with suspected acute respiratory failure. MATERIAL AND METHODS: A prospective, observational multicentre study was conducted in the emergency departments of 3 Spanish hospitals. RESULTS: The study included 166 patients who presented mean±standard deviation PaO2, SpO2 and fraction of inspired oxygen (FiO2) values of 61.64±17.3mmHg, 87.61±8.8% and 0.28±0.15%, respectively. The median PaO2/FiO2 and SpO2/FiO2 ratios were 256.6 and 359.2, respectively. The correlation between PaO2/FiO2 and the SpO2/FiO2 was 0.745 (P<.001). CONCLUSIONS: The SpO2/FiO2 ratio can be used to calculate PaO2/FiO2 and determine the oxygenation state of patients with acute respiratory failure.
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OBJECTIVE: The aim of this exploratory study was to analyze the urinary excretion of Clara cell protein (CC16), a new marker of proximal tubular dysfunction (PTD), in kidney transplantation (KT). MATERIALS AND METHODS: Urinary concentrations of CC16, ß2-microglobulin (ß2m), and N-acetyl-glucosaminidase (NAG) were measured in 50 KT patients (72% men; mean age 50.4 ± 12.4 years; diabetes in 24%; duration of KT 4.3 ± 3.1 years) and 10 healthy controls (6 men; mean age 33.6 ± 13.4 years). RESULTS: Urinary levels of ß2m, NAG, and CC16 were significantly higher in KT patients than in controls: ß2m: 0.77 (interquartile range [IQ] 0.22 to 4.62) g/g vs 0.069 (IQ 0.05 to 0.10) g/g; NAG: 3.16 (IQ 2.09 to 5.33) U/g vs 1.73 (IQ 1.25 to 2.07) U/g; CC16: 26.01 (IQ 8.62 to 123.3) g/g vs 2.51 (IQ 0.83 to 7.18) g/g (P < .001). Elevated levels of ß2m, NAG, and CC16 were found in 81%, 28%, and 71% of KT patients, respectively. Urinary levels of ß2m, NAG, and CC16 significantly increase as glomerular filtration rate (GFR) decreases. Interestingly, in patients with GFR >60 mL/min, we still found high levels of ß2m, NAG, and CC16 in 77%, 13%, and 52%, respectively. Diabetic subjects had significant higher levels of the 3 markers compared with nondiabetic subjects, without differences in albumin excretion or GFR. CC16 showed a positive correlation with urinary albumin (r = 0.42, P < .001), NAG (r = 0.352, P < .05), and ß2m (r = 0.75, P < .001). CONCLUSION: PTD is highly prevalent in KT patients. This is the first study that analyzes CC16 in KT patients, showing that the urinary excretion of this protein is significantly increased in this population. Further studies are needed to examine the clinical value of CC16 in KT patients.
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Síndrome de Fanconi/urina , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/urina , Uteroglobina/urina , Acetilglucosaminidase/urina , Adulto , Albuminúria/urina , Biomarcadores/urina , Estudos de Casos e Controles , Diabetes Mellitus/urina , Síndrome de Fanconi/etiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco , Microglobulina beta-2/urinaRESUMO
This article refers to the paper "Assessment of table olive fermentation by functional data analysis" (Ruiz-Bellido et al., 2016) [1]. The dataset include pH, titratable acidity, yeast count and area values obtained during fermentation process (380 days) of Aloreña de Málaga olives subjected to five different fermentation systems: i) control of acidified cured olives, ii) highly acidified cured olives, iii) intermediate acidified cured olives, iv) control of traditional cracked olives, and v) traditional olives cracked after 72 h of exposure to air. Many of the Tables and Figures shown in this paper were deduced after application of Functional Data Analysis to raw data using a routine executed under R software for comparison among treatments by the transformation of raw data into smooth curves and the application of a new battery of statistical tools (functional pointwise estimation of the averages and standard deviations, maximum, minimum, first and second derivatives, functional regression, and functional F and t-tests).
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For the first time, functional data analysis (FDA) was used to assess the effects of different treatments on Protection Denomination of Origin Aloreña de Málaga table olive fermentations, focusing on the evolution of yeast population. The analysis of fermentation by a conventional approach led to scarce information. However, the transformation of microbial (and also physicochemical) data into smooth curves allowed the application of a new battery of statistical tools for the analysis of fermentations (functional pointwise estimation of the averages and standard deviations, maximum, minimum, first and second derivatives, functional regression, and functional F and t-tests). FDA showed that all the treatments assayed led to similar trends in yeast population while changes in pH and titratable acidity profiles led to several significant differences. Therefore, FDA represents a promising and valuable tool for studying table olive fermentations and for food microbiology in general.
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Fermentação , Microbiologia de Alimentos/métodos , Olea/microbiologia , Leveduras/metabolismo , Interpretação Estatística de Dados , Concentração de Íons de Hidrogênio , Leveduras/crescimento & desenvolvimentoRESUMO
INTRODUCTION: Treatment adherence is a factor that is affecting the effectiveness of antiepileptic drugs. Levetiracetam is a drug whose effectiveness and safety is well established and is available in different oral formulations (granulates in sachets, tablets, oral solution), but information on treatment adherence/compliance with these oral formulations is limited. AIM: To determine treatment adherence with levetiracetam formulations (granulates in sachets, tablets) in adult and elderly people. PATIENTS AND METHODS: Retrospective observational non-interventionist study. During the three months before the study patients should be treated with levetiracetam (granulates in sachets or tablets), either alone or in combination. Compliance tests (Green-Morisky modified test) as well as a satisfaction questionnaire investigator and patient/caregiver is assessed. Data were analyzed using SPSS v. 21.0 program. RESULTS: A total of 466 patients completed the study. The average age was 52.75 ± 19.17 years old and the average over 65 years of 72.79 ± 6.15. 55.4% were men. Compliance is related to the variable 'pharmaceutical formulation' and with age (p = 0.031). The risk of non-compliance was 86.4% higher among those taking tablets versus granulates in sachets of levetiracetam (odds ratio: 1.864). Likewise, the non-compliance was greater among patients over 65 years. The non-compliance was related to attributing of memory failures. CONCLUSIONS: Patients older are more difficult to compliance. The granulates levetiracetam in sachets improves compliance.
TITLE: Adhesion al tratamiento con levetiracetam: estudio observacional retrospectivo no intervencionista.Introduccion. La adhesion al tratamiento es un factor que esta repercutiendo en la eficacia de los farmacos antiepilepticos. El levetiracetam es un principio activo cuya eficacia y seguridad estan ampliamente demostradas y que esta disponible en diferentes formulaciones orales (sobres, comprimidos y solucion oral), pero la informacion sobre la adhesion/cumplimiento del tratamiento con estas formulaciones orales es escasa. Objetivo. Conocer la adhesion al tratamiento con formulaciones de levetiracetam (granulado en sobre y comprimidos) en adultos y ancianos. Pacientes y metodos. Estudio observacional retrospectivo no intervencionista. Durante los tres meses previos al estudio debia estar en tratamiento con levetiracetam (granulado en sobre o comprimidos), bien en monoterapia o en combinacion. Se valoraron los tests de cumplimiento (cuestionario de Morisky-Green modificado), asi como un cuestionario de satisfaccion del investigador y del paciente/cuidador. Los datos se analizaron con el programa SPSS v. 21.0. Resultados. Un total de 466 pacientes completaron el estudio. La edad media fue de 52,75 ± 19,17 años, y la media en los mayores de 65 años fue de 72,79 ± 6,15 años. Un 55,4% eran hombres. El cumplimiento se relaciona con la variable 'formulacion galenica' y con la edad (p = 0,031). El riesgo de incumplimiento es un 86,4% mayor entre los que toman comprimidos frente a granulado de levetiracetam (odds ratio: 1,864). Asimismo, el incumplimiento es mayor entre los pacientes mayores de 65 años. El incumplimiento se relaciona con la atribucion de fallos de memoria. Conclusiones. Los pacientes mas mayores presentan mas dificultades en el cumplimiento. El granulado de levetiracetam en sobres favorece el cumplimiento.
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Anticonvulsivantes/uso terapêutico , Adesão à Medicação , Piracetam/análogos & derivados , Adulto , Idoso , Feminino , Humanos , Levetiracetam , Masculino , Pessoa de Meia-Idade , Piracetam/uso terapêutico , Estudos RetrospectivosRESUMO
Introducción: El objetivo del estudio fue analizar la evolución del estrés en las familias de niños o adolescentes que comienzan tratamiento psicofarmacológico, tras ser diagnosticados de un trastorno por déficit de atención con hiperactividad (TDAH), y la capacidad de detección de este cambio mediante el cuestionario Family Strain Index (FSI). Metodología: Cuarenta y ocho especialistas en psiquiatría infanto-juvenil o neuropediatría incluyeron 429 familias de niños diagnosticados de TDAH, representadas por el padre, la madre o el tutor del niño. En la visita basal, a los 2 y 4 meses, se evaluó la intensidad de los síntomas del TDAH mediante la escala de Conners abreviada, y el estrés familiar mediante el cuestionario FSI. Resultados: Se observó: a) mejoría en la puntuación global del FSI y en todas sus dimensiones (p<0,001); b) mejoría en la intensidad de los síntomas de hiperactividad (Conners, p<0,0001);c) una buena concordancia entre las 2 escalas, a los 2 meses (R-intraclase 0,825, p<0,0001) y a los 4 meses de seguimiento (R-intraclase 0,784, p<0,0001). El 97,9% de los niños (420) recibieron tratamiento con metilfenidato de liberación modificada. Conclusiones: Se observó una correlación significativa entre la evolución positiva de los síntomas de los niños con TDAH y la reducción del estrés familiar evaluado mediante el cuestionario FSI, tras la instauración del tratamiento psicofarmacológico. Este estudio demostró una gran sensibilidad al cambio de la situación clínica de los pacientes con TDAH evaluado a través del estrés producido sobre sus familias. Se recomienda el uso de este cuestionario como medida indirecta de la repercusión del trastorno sobre el entorno del niño con TDAH en términos de estrés familiar (AU)
Introduction. The objective of this study was to assess the evolution of stress in families of children and adolescents who start psychopharmacological treatment after being diagnosed with attention deficit hyperactivity disorder (ADHD), and the ability to detect this change using the FSI (Family Strain Index) questionnaire. Methodology: Forty eight (48) specialists in child-adolescent psychiatry or neuropediatrics included 429 families of children diagnosed with ADHD, represented by the father, mother or guardian of the child. In the baseline visit, and at two and four months, the intensity of the symptoms of ADHD was evaluated using the abbreviated Conners scale, and family stress was evaluated using the FSI questionnaire. Results: The following was observed: a) an improvement in the overall FSI score and in all its dimensions (P<.001); b) an improvement in the intensity of the symptoms of hyperactivity (Conners, P<.0001); c) good agreement between these two scales at two months (R-intraclass 0.825, P<.0001) and at four months of follow-up (R-intraclass 0.784, P<.0001). Ninety seven point nine percent (97.9%) of the children or adolescents (420) received treatment with modified-release methylphenidate. Conclusions: There was a significant relationship between the positive evolution of symptoms in children with ADHD and the reduction of family stress, as evaluated by the FSI questionnaire, after starting psychopharmacological treatment. This study showed a great sensitivity to change in the clinical situation of patients with ADHD, evaluated through the stress it produces on its families. It is recommended to use this questionnaire as an indirect measurement of the repercussions of the disorder on the environment of the child with ADHD in terms of family stress (AU)
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Adolescente , Criança , Feminino , Humanos , Masculino , Estresse Psicológico/patologia , Estresse Psicológico/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Qualidade de Vida/psicologia , Diagnóstico Duplo (Psiquiatria)/métodos , Diagnóstico Duplo (Psiquiatria)/psicologia , Inquéritos e Questionários/classificação , Estudo Observacional , Estresse Psicológico/complicações , Estresse Psicológico/metabolismo , Transtorno do Deficit de Atenção com Hiperatividade/metabolismo , Transtorno do Deficit de Atenção com Hiperatividade/patologia , Diagnóstico Duplo (Psiquiatria)/classificação , Diagnóstico Duplo (Psiquiatria)/normas , Inquéritos e Questionários/normasRESUMO
This work studies the effects of the partial substitution of NaCl with potassium and calcium chloride salts on the fermentation profile of Spanish-style green Manzanilla olives. For this purpose, response surface methodology based in an enlarged simplex centroid mixture design with constrain (∑salts = 100 g/L) was used. Regarding to physicochemical characteristics, pH decreased when CaCl2 increased, titratable acidity was lower in presence of KCl while combined acidity increased as the contents of KCl and CaCl2 were close to the barycentre of the experiment (â¼33.33% each salt). Regarding to microbiological profile, Enterobacteriaceae growth was slight stimulated in presence of high CaCl2 contents, yeast patterns were not linked to the initial brine compositions, while the maximum lactic acid bacteria population decreased slightly as KCl and CaCl2 increased in the proportion 1:1, although a moderate (equilibrated) content of both may be stimulating. Results obtained in this work show that Spanish-style green Manzanilla cv. can be fermented in diverse mixtures of chloride salts, albeit the initial CaCl2 should be limited to 20-30 g/L to prevent excessive Enterobacteriaceae growth; combining it with a similar proportion of KCl may also improve LAB predominance.
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Olea/microbiologia , Sais/análise , Cloreto de Sódio/análise , Enterobacteriaceae/crescimento & desenvolvimento , Enterobacteriaceae/metabolismo , Fermentação , Microbiologia de Alimentos , Frutas/química , Frutas/microbiologia , Lactobacillaceae/crescimento & desenvolvimento , Lactobacillaceae/metabolismo , Olea/química , Cloreto de Sódio/metabolismo , Espanha , Leveduras/crescimento & desenvolvimento , Leveduras/metabolismoRESUMO
INTRODUCTION: The objective of this study was to assess the evolution of stress in families of children and adolescents who start psychopharmacological treatment after being diagnosed with attention deficit hyperactivity disorder (ADHD), and the ability to detect this change using the FSI (Family Strain Index) questionnaire. METHODOLOGY: Forty eight (48) specialists in child-adolescent psychiatry or neuropediatrics included 429 families of children diagnosed with ADHD, represented by the father, mother or guardian of the child. In the baseline visit, and at two and four months, the intensity of the symptoms of ADHD was evaluated using the abbreviated Conners scale, and family stress was evaluated using the FSI questionnaire. RESULTS: The following was observed: a) an improvement in the overall FSI score and in all its dimensions (P<.001); b) an improvement in the intensity of the symptoms of hyperactivity (Conners, P<.0001); c) good agreement between these two scales at two months (R-intraclass 0.825, P<.0001) and at four months of follow-up (R-intraclass 0.784, P<.0001). Ninety seven point nine percent (97.9%) of the children or adolescents (420) received treatment with modified-release methylphenidate. CONCLUSIONS: There was a significant relationship between the positive evolution of symptoms in children with ADHD and the reduction of family stress, as evaluated by the FSI questionnaire, after starting psychopharmacological treatment. This study showed a great sensitivity to change in the clinical situation of patients with ADHD, evaluated through the stress it produces on its families. It is recommended to use this questionnaire as an indirect measurement of the repercussions of the disorder on the environment of the child with ADHD in terms of family stress.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Saúde da Família , Estresse Psicológico , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Humanos , Metilfenidato/uso terapêutico , Inquéritos e QuestionáriosRESUMO
Objetivo. Las gammapatías biclonales se caracterizan por una proliferación clonal de cálulas plasmáticas, o sus progenitores linfoides B, con producción de dos inmunoglobulinas anormales (proteínas M o paraproteínas). No conocemos estudios que hayan analizado esta patología en España. Hemos estudiado las enfermedades subyacentes, características de las paraproteínas y evolución de una serie de pacientes con gammapatía biclonal. Material y métodos. Se revisaron las gammapatías clonales del Servicio de Inmunología del Hospital Puerta de Hierro de Madrid, entre los años 1970 y 2011, seleccionando aquellos pacientes con gammapatía biclonal en una determinación. Se recogieron datos epidemiológicos, enfermedad de base, patologías asociadas, terapias recibidas, paraproteína y cuantificación de inmunoglobulinas. Resultados. De los 1.626 casos de gammapatías clonales, 47 eran gammapatía biclonal (2,89%). La mediana de seguimiento fue de 2 años. La principal entidad asociada fue la gammapatía biclonal de significado indeterminado. La composición de paraproteínas más frecuente fue IgG-IgG. En el 81% de los pacientes con una segunda determinación de paraproteína, había desaparecido al menos un componente M. Un tercio de los pacientes no había recibido tratamiento. Conclusiones. Las gammapatías biclonales se asocian fundamentalmente a gammapatía biclonal de significado indeterminado. Ninguna gammapatía biclonal de significado indeterminado evolucionó a patología maligna. En un elevado porcentaje desapareció al menos uno de los dos componentes clonales, a veces de forma espontánea (AU)
Objectives. Biclonal gammopathies are characterized by the clonal proliferation of plasma cells or their B-lymphoid progenitors and are associated with the production of abnormal immunoglobulins (M proteins or paraproteins). There are no known studies that have analyzed this disease in Spain. We studied the underlying diseases, characteristics of paraproteins and the evolution of a series of patients with biclonal gammopathy. Material and methods. We reviewed clonal gammopathies at the Department of Immunology of Hospital Puerta de Hierro in Madrid, between 1970 and 2011, selecting those patients with biclonal gammopathy in one reading. We collected data on the patient's epidemiology, underlying disease, associated diseases, therapies and paraprotein and immunoglobulin levels. Results. Of the 1626 cases of clonal gammapathies, 47 were biclonal gammopathy (2.89%). The median follow-up was 2 years. The main associated condition was biclonal gammopathies of undetermined significance (BGUS). The most common paraprotein combination was IgG-IgG. Upon conducting a second paraprotein reading, 81% of the patients had lost at least 1 monoclonal component. A third of the patients had not undergone treatment. Conclusions. Biclonal gammopathy are fundamentally associated with biclonal gammopathies of undetermined significance. No biclonal gammopathies of undetermined significance evolved to a malignant disease. In a high percentage of patients, at least 1 of the 2 clonal components disappeared, sometimes spontaneously (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Paraproteinemias/diagnóstico , Imunoglobulinas/análise , Imunoglobulinas , Eletroforese em Gel de Ágar/métodos , Eletroforese em Gel de Ágar/tendências , Densitometria/métodos , Paraproteinemias/epidemiologia , Estudos Retrospectivos , Genes de Cadeia Leve de Imunoglobulina/imunologia , Genes de Cadeia Leve de Imunoglobulina/fisiologiaRESUMO
OBJECTIVES: Biclonal gammopathies are characterized by the clonal proliferation of plasma cells or their B-lymphoid progenitors and are associated with the production of abnormal immunoglobulins (M proteins or paraproteins). There are no known studies that have analyzed this disease in Spain. We studied the underlying diseases, characteristics of paraproteins and the evolution of a series of patients with biclonal gammopathy. MATERIAL AND METHODS: We reviewed clonal gammopathies at the Department of Immunology of Hospital Puerta de Hierro in Madrid, between 1970 and 2011, selecting those patients with biclonal gammopathy in one reading. We collected data on the patient's epidemiology, underlying disease, associated diseases, therapies and paraprotein and immunoglobulin levels. RESULTS: Of the 1626 cases of clonal gammapathies, 47 were biclonal gammopathy (2.89%). The median follow-up was 2 years. The main associated condition was biclonal gammopathies of undetermined significance (BGUS). The most common paraprotein combination was IgG-IgG. Upon conducting a second paraprotein reading, 81% of the patients had lost at least 1 monoclonal component. A third of the patients had not undergone treatment. CONCLUSIONS: Biclonal gammopathy are fundamentally associated with biclonal gammopathies of undetermined significance. No biclonal gammopathies of undetermined significance evolved to a malignant disease. In a high percentage of patients, at least 1 of the 2 clonal components disappeared, sometimes spontaneously.