[Repetition of microbiological tests in suspect of SARS-CoV-2 infection: utility of a score based on clinical probability]. / Repetición de las pruebas microbiológicas en la sospecha de la infección por SARS-CoV-2: utilidad de un score basado en la probabilidad clínica.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities. METHODS: Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG. RESULTS: A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p<0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p<0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%. CONCLUSIONS: We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios.

Thermal Degradation Kinetics of ZnO/polyester Nanocomposites.

ZnO particles were synthetized by the sol-gel method and subsequent heat treatment of 400, 500 and 600 °C was applied. The nano ZnO particles were incorporated to the unsaturated polyester resin by solution blending at 0.05 wt % concentration. X-ray diffraction detected the formation of a wurtzite-like structure. Viscoelastic behavior of neat polyester and nanocomposites revealed the nano ZnO particles does not promote better mechanical properties because of a weak interaction and the glass transition temperature of the polyester was favored by the presence of a higher quantity of nano-size ZnO particles. Thermogravimetric analysis at 5, 10 and 20 °C/min allowed determining the degradation kinetic parameters based on the Friedman and Kissinger models for neat polyester and nanocomposites. Heating rates promoted an increase in the temperature degradation and the addition of ZnO particles promoted a catalyst effect that reduce the amount of thermal energy needed to start the thermal degradation.

Nickelocene as precursor of microporous organometallic-derived carbon and nickel oxide-carbon nanocomposite.

Microporous flower-like and spherical carbon particles, made of graphene-like layers, have been obtained via chlorination of nickelocene (Ni(C5H5)2). Their mechanism of formation, in terms of morphology and micro-nanostructure, has been followed from 200 to 900°C. Conventional transmission electron microscopy and high-resolution-TEM observations allow determining that their structure is made of highly disordered graphene-like layers. The Raman spectrum of the high temperature sample exhibits the characteristics D and G bands. The peak positions, the ratio of their intensities (ID/IG) and full width at half maximum suggest a high degree of disorder in the nanostructures. The calculated in-plane correlation length of these graphene-like layers is 1.15nm. In all the carbon particles, electron energy-loss spectroscopy shows sp2 carbon bonding content higher than 95% and mass density in the range of 1.0-1.6g/cm3. Textural studies show Type I adsorption isotherms with surface area of 922m2/g for the sample produced at 900°C. In addition, the basic hydrothermal treatment of the sample chlorinated at 600°C yields a composite material with NiO nanoparticles well dispersed within the carbon matrix.

[How to prescribe for patients with dysphagia: a review for the adaptation of the pharmaceutical guide in a socio-sanitary hospital]. / Adaptación de la guía farmacoterapéutica de un hospital sociosanitario a pacientes con disfagia.

PURPOSE: The aims of this paper are to review the pharmaceutical guide in order to include suitable dosage forms for patients with dysphagia and to establish specific recommendations for the drug administration. METHODS: A comprehensive literature review was performed to develop general recommendations. Three topics were checked for every drug: a) alternative dosage forms suitable to patients with dysphagia; b) appropriateness of crushing tablets and opening capsules; and c) are these drugs suitable be mixed with food? RESULTS: An algorithm was designed in order to help clinicians to select the best pharmaceutical form and its optimal administration method. The former pharmaceutical guide was modified and handling recommendations were made for each drug. Eleven dispersable, 26 liquid and 8 powder new forms were included. CONCLUSIONS: This work has turned the pharmaceutical guide of the hospital in a useful tool for the prescription, validation and administration of medicines to patients with dysphagia.

Objetivo: Revisar la guía farmacoterapéutica del hospital para incluir formas farmacéuticas adaptadas a pacientes con disfagia y recomendaciones para la administración de medicamentos en estos pacientes. Método: Se realizó una búsqueda bibliográfica para elaborar las recomendaciones generales de administración de medicamentos en disfagia. Se comprobó para cada principio activo: a) si existían comercializadas otras formas farmacéuticas más recomendables; b) si había posibilidad de manipular los comprimidos o cápsulas, y c) si eran compatibles con alimentos. Resultados: Se desarrolló un algoritmo de decisión para ayudar en la selección de la forma farmacéutica y de su método de administración. Se incluyó un apartado de recomendaciones de administración para cada principio activo. La búsqueda supuso la inclusión de once formas bucodispersables, veintiséis líquidas y ocho como polvo. Conclusiones: La revisión mejorará la utilidad de la guía como instrumento para la prescripción, validación y administración de medicamentos en disfagia.

Adaptación de la guía farmacoterapéutica de un hospital sociosanitario a pacientes con disfagia / How to prescribe for patients with dysphagia: a review for the adaptation of the pharmaceutical guide in a socio-sanitary hospital

Objetivo: Revisar la guía farmacoterapéutica del hospital para incluir formas farmacéuticas adaptadas a pacientes con disfagia y recomendaciones para la administración de medicamentos en estos pacientes. Método: Se realizó una búsqueda bibliográfica para elaborar las recomendaciones generales de administración de medicamentos en disfagia. Se comprobó para cada principio activo: a) si existían comercializadas otras formas farmacéuticas más recomendables; b) si había posibilidad de manipular los comprimidos o cápsulas, y c) si eran compatibles con alimentos. Resultados: Se desarrolló un algoritmo de decisión para ayudar en la selección de la forma farmacéutica y de su método de administración. Se incluyó un apartado de recomendaciones de administración para cada principio activo. La búsqueda supuso la inclusión de once formas bucodispersables, veintiséis líquidas y ocho como polvo. Conclusiones: La revisión mejorará la utilidad de la guía como instrumento para la prescripción, validación y administración de medicamentos en disfagia (AU)

Pourpose: The aims of this paper are to review the pharmaceutical guide in order to include suitable dosage forms for patients with dysphagia and to establish specific recommendations for the drug administration. Methods: A comprehensive literature review was performed to develop general recommendations. Three topics were checked for every drug: a) alternative dosage forms suitable to patients with dysphagia; b) appropriateness of crushing tablets and opening capsules; and c) are these drugs suitable be mixed with food? Results: An algorithm was designed in order to help clinicians to select the best pharmaceutical form and its optimal administration method. The former pharmaceutical guide was modified and handling recommendations were made for each drug. Eleven dispersable, 26 liquid and 8 powder new forms were included. Conclusions: This work has turned the pharmaceutical guide of the hospital in a useful tool for the prescription, validation and administration of medicines to patients with dysphagia (AU)

Influencia de la diabetes mellitus en los sujetos con enfermedad pulmonar obstructiva crónica en un ámbito ambulatorio / Influence of the diabetes mellitus in the subjects with chronic obstructive pulmonary disease in setting ambulatory

No disponible

[Economic evaluation of acute migraine attack treatment with triptans in Spain]. / Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España.

OBJECTIVE: To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness. METHODS: A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 h--anti-migraine response, pain free at 2 h, and 24 h--sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed. RESULTS: Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h--anti-migraine response (16.50 and 17.44e) and with 24 h--sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e). CONCLUSIONS: Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out.

Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España / Economic evaluation of acute migraine attack treatment with triptans in Spain

Objetivo. Realizar una evaluación económica del tratamiento del ataque de migraña con triptanes, a sus dosis habituales, utilizando tres medidas de efectividad antimigrañosa. Métodos. Se realizó un análisis coste/efectividad (ACE) desde la perspectiva del Sistema Nacional de Salud, a precios de 2003, comparando almotriptán 12,5 mg, eletriptán 40 mg, naratriptán 2,5 mg, rizatriptán 10 mg, sumatriptán 50 mg, sumatriptán 100 mg, zolmitriptán 2,5 mg y zolmitriptán 5 mg. Los valores de efectividad se obtuvieron de un metaanálisis de eficacia de ensayos clínicos publicados y fueron la ganancia terapéutica (GT) (efecto antimigrañoso tras sustraer el efecto placebo) de respuesta antimigrañosa a las 2 h, ausencia de dolor a las 2 h y respuesta completa. Se determinaron las tasas de medicación de rescate y recurrencia a las 24 h. Resultados. Se incluyeron 38 ensayos clínicos (19.872 pacientes). El eletriptán 40 mg y el rizatriptán 10 mg presentaron la mayor GT en respuesta completa (20,2 % en ambos casos), ausencia de dolor a las 2 h (27,7 y 32,2 %) y respuesta antimigrañosa a las 2 h (38,6 y 31,3 %), respectivamente. Se usó menos medicación de rescate con eletriptán 40 mg y sumpatriptán 50 mg (21 y 20 %) y la recurrencia fue menor con eletriptán 40 mg y naratriptán 2,5 mg (27 y 21 %). Los menores costes por ataque de migraña con respuesta a las 2 h y con respuesta completa se observaron con eletriptán 40 mg (16,50 y 31,47e) y con sumatriptán 50 mg (17,44 y 33,61e), respectivamente, mientras que el menor coste en ausencia de dolor a las 2 h se observó con rizatriptán 10 mg (21,36e) y eletriptán 40 mg (22,99e). Conclusiones. Considerando las medidas de coste-efectividad evaluadas, el eletriptán 40 mg fue el triptán más eficiente en la mayoría de los análisis efectuados

Objective. To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness. Methods. A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 hanti- migraine response, pain free at 2 h, and 24 h-sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed. Results. Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h-antimigraine response (16.50 and 17.44e) and with 24 h-sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e). Conclusions. Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out

[Visual neglect secondary to left frontal haemorrhage]. / Negligencia visual secundaria a hemorragia frontal izquierda.

INTRODUCTION: The term visual neglect refers to a lack of attention to visual stimuli coming from the contralateral hemifield. The patient does not seek objects in the abnormal field and often only sees half of a paragraph when reading. Although the right inferior parietal lobe is the most frequently damaged region, the same symptomatology can be due to injury to the frontal lobe, the basal ganglia and the thalamus. CASE REPORT: Female aged 71 with a mitral prosthesis and atrial fibrillation in treatment with dicumarols, who presented a left frontal parenchymatous haemorrhage. The exploration revealed right visual hemineglect without ipsilateral homonymous hemianopsia, associated to a right hemiparesis. DISCUSSION: Even when visual neglect has been described in lesions affecting the parietal lobe, especially on the right hand side, the same symptomatology can be due to injury to the basal ganglia, the thalamus and the frontal lobe. In this last case, it seems that the basis for the pathogenesis lies in the damage done to the underlying white matter, which would disconnect the posterior parietal cortex from the prefrontal cortex.

Negligencia visual secundaria a hemorragia frontal izquierda / Visual neglect secondary to left frontal haemorrhage

Introducción. El término negligencia visual hace referencia a una falta de atención a los estímulos visuales procedentes del hemicampo contralateral. El paciente no busca objetos en el campo anormal, y a menudo sólo lee la mitad del párrafo. Si bien el lóbulo parietal inferior derecho es la región más frecuentemente lesionada, la misma sintomatología puede obedecer a lesiones del lóbulo frontal, ganglios de la base y tálamo. Caso clínico. Mujer de 71 años de edad portadora de prótesis mitral con fibrilación auricular y en tratamiento con dicumarínicos, que presenta una hemorragia parenquimatosa frontal izquierda. En la exploración se objetivó una heminegligencia visual derecha sin hemianopsia homónima ispilateral, asociada a una hemiparesia derecha. Discusión. Aun cuando la negligencia visual se ha descrito en lesiones que afectan al lóbulo parietal, sobre todo el derecho, la misma sintomatología puede obedecer a lesiones de los ganglios de la base, tálamo y lóbulo frontal. En este último supuesto, parece ser que la base patogénica radica en la afectación de la sustancia blanca subyacente, que desconectaría el córtex parietal posterior del córtex prefrontal (AU)

Introduction. The term visual neglect refers to a lack of attention to visual stimuli coming from the contralateral hemifield. The patient does not seek objects in the abnormal field and often only sees half of a paragraph when reading. Although the right inferior parietal lobe is the most frequently damaged region, the same symptomatology can be due to injury to the frontal lobe, the basal ganglia and the thalamus. Case report. Female aged 71 with a mitral prosthesis and atrial fibrillation in treatment with dicumarols, who presented a left frontal parenchymatous haemorrhage. The exploration revealed right visual hemineglect without ipsilateral homonymous hemianopsia, associated to a right hemiparesis. Discussion. Even when visual neglect has been described in lesions affecting the parietal lobe, especially on the right-hand side, the same symptomatology can be due to injury to the basal ganglia, the thalamus and the frontal lobe. In this last case, it seems that the basis for the pathogenesis lies in the damage done to the underlying white matter, which would disconnect the posterior parietal cortex from the prefrontal cortex (AU)

[Arterial hypertension in the elderly. The outstanding aspects]. / Hipertensión arterial en el anciano. Aspectos destacables.

Arterial hypertension (AHT) is one of the principal health problems facing the community today. Because the prevalence of AHT among the elderly is high and management of the condition is problematic, concern is increasing as the population ages. This article provides the following: a) a short summary of epidemiological data, the most important being the criteria used to define the disease, which has a prevalence of around 50% in patients over 65 years of age (and higher among women); b) a discussion of the role of AHT as a risk factor in the elderly; c) a review of the most important findings and conclusions from studies carried out among the elderly, and d) some final considerations toward the eventual formulation of treatment guidelines.