Terapia farmacológica en la prevención secundaria del ictus isquémico en los muy ancianos: ¿ha mejorado en las últimas décadas? / Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades?

Introduction Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. Method Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999–2001, 2014−16 and 2019−2020. VEP were considered those with ≥80 years. Result We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ± 3 vs. 84.1 ± 3 vs. 85.2 ± 4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ± 0.9 vs. 1.6 ± 0, 9 vs. 1.9 ± 0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. Conclusions In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement (AU)

Introducción El envejecimiento poblacional ha provocado un aumento de los ictus en los pacientes muy ancianos (PMA). Valoramos cómo ha cambiado la prevención secundaria del ictus isquémico en PMA en las últimas décadas. Método Estudio retrospectivo de las altas por ictus isquémico en los hospitales Virgen Macarena, Virgen del Rocío y Virgen de Valme de Sevilla (España), durante los períodos 1999-2001, 2014-2016 y 2019-2020. Se consideró PMA ≥ 80 años. Resultado Estudiamos a 1.806 pacientes, de los cuales 349 (19,3%) eran PMA. Con los años se han duplicado los PMA (13,5% vs. 25,9% y 28%; p = 0,0001) y aumentado la edad (83,3 ± 3 vs. 84,1 ± 3 vs. 85,2 ± 4; p = 0,001). Comparando los períodos, los PMA tienen más hipertensión (69,9 vs. 84,8% vs. 84,6%; p = 0,0001) y dislipidemia (12 vs. 41,7% vs. 52,3%; p = 0,0001) y tienen prescritos más antihipertensivos (69,1% vs. 86,7% vs. 92,3%; p = 0,0001), estatinas (5,3% vs. 78% vs. 81,5%; p = 0,0001) y anticoagulantes (16,5% vs. 19,4% vs. 53,1%; p = 0,001); también ha aumentado el número de antihipertensivos (1 ± 0,9 vs. 1,6 ± 0,9 vs. 1,9 ± 0,8 fármacos; p = 0,0001) y de estatinas de alta intensidad (2,3% vs. 42,7% vs. 69,2%; p = 0,0001). Comparando los PMA con pacientes más jóvenes, no hubo diferencias en el tratamiento antihipertensivo en ningún período, aunque sí hubo diferencias en el tratamiento antitrombótico en el primer período y con las estatinas las diferencias se mantuvieron hasta el final. Conclusiones En los últimos 20 años el número de PMA se ha duplicado y supera la cuarta parte de las altas. Aunque existe mejoría en la prevención secundaria del ictus en los PMA, existe margen de mejora (AU)

Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades?

INTRODUCTION: Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. METHOD: Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999-2001, 2014-16 and 2019-2020. VEP were considered those with ≥80 years. RESULT: We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ±â€¯3 vs. 84.1 ±â€¯3 vs. 85.2 ±â€¯4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ±â€¯0.9 vs. 1.6 ±â€¯0, 9 vs. 1.9 ±â€¯0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. CONCLUSIONS: In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement.

Understanding the impact of the COVID-19-related lockdown in university workers. Identifying groups through cluster analysis.

Objective: To analyse the COVID-19-related lockdown impact on University workers, to identify groups based on this information, and to study the factors associated with each group. Study design: Cross-sectional study. Methods: A survey was conducted 3.5 weeks after COVID-19-related lockdown in University workers in Spain. Sociodemographic variables, housing, work, health conditions, levels of anxiety, stress and depression (DASS-21), and social support (MSPSS) were collected. A cluster analysis was performed to identify groups depending on the impact of the lockdown. Differences between groups were tested using Chi-square and Mann-Whitney-U tests, and associated factors with binary logistic regression. Results: We identified two groups of workers. "G1: Consequences in the daily life routine" was mainly composed of men, Research and Teaching Personnel (RTP) with more stable professional categories, higher income level, and bigger houses than people in G2. Participants in "G2: Concerns for the current and future well-being" presented worse intensity of pain than before the lockdown, more anxiety, depression, stress and less social support than people in G1. ASP (Administration and Services Personnel) had more risk of belonging to G2 than RTP (OR = 5.863). A higher number of people living at home decreased the risk of being in G2 (OR = 0.439). People with lower pain intensity had less risk of being in G2 (OR = 0.014), and this risk decreased as friends support increased (OR = 0.833). Conclusions: In G1, the consequences were immediately reflected in the stress resulting from changes in their daily work routine. In G2, the concerns were related to their professional future, with worse mental health, greater intensity of pain and less social support.

Giant mature cystic teratoma of the mediastinum resected by VATS: a case report.

The incidence of mediastinal teratomas is low, it's important to recognize them between all the differential diagnoses for mediastinal tumors. The treatment is surgical resection. We report a giant mature cystic teratoma of the mediastinum in a 40-year-old woman. She presented with dyspnea, flu-like symptoms during the previous 5 days. An x-ray complemented with a chest CT scan showed a heterogeneous extrapulmonary multiloculated and predominantly fluid density tumor located at the left side of the mediastinum. The patient underwent resection by video-assisted thoracic surgery (VATS). The tumor was 15 cm in diameter with a predominant cystic component. Histologic examination revealed a mature cystic teratoma. Treatment of these tumors should attempt a complete resection. Open approaches are painful, require a longer recovery and are associated with higher morbidity. VATS has been used to treat these tumors, demonstrating the same effectiveness and advantages over open procedures.

Factores psicológicos asociados a la adherencia al tratamiento analgésico en pacientes con dolor crónico: revisión sistemática de la literatura / Psychological factors associated with the adherence to analgesic treatment in patients with chronic pain: systematic review of the literature

Introducción: La falta de adherencia terapéutica es frecuente en pacientes con dolor crónico (DC) y la influencia de factores psicológicos sobre ella puede ser relevante. El objetivo del estudio es analizar los factores psicológicos relacionados con la adherencia al tratamiento analgésico en paciente con DC. Metodología: Se realizó una revisión sistemática donde se incluyeron artículos originales publicados en inglés y castellano entre junio de 2009 y junio de 2019 incluidos en Pudmed, Scopus, Web of Science y PsycINFO. Se incluyeron artículos con diseño transversal y longitudinal, llevados a cabo en una población > 18 años con dolor crónico no oncológico (DCNO) y que analizaban cualquier variable psicológica en relación con la adherencia al tratamiento analgésico. Los términos de búsqueda fueron "adherence", "compliance", "misuse", "analgesic", "chronic pain" y "psychology". La calidad de los artículos incluidos se analizó mediante la Critical Appraisal Checklist for Analytical Cross-sectional studies de Joanna Briggs Institute para los estudios transversales y Newcastle-Ottawa Quality Assessment Form for Cohort Studies para los longitudinales. Resultados: Se identificaron 1184 artículos, de los cuales 14 fueron finalmente seleccionados. La depresión fue la variable más estudiada, incluida en 11 artículos, seguida de la ansiedad, que apareció en 6. Tanto la depresión como la ansiedad se asociaron de manera constante y significativa con una menor adherencia al tratamiento analgésico, y lo mismo fue cierto en dos de los artículos que miden conjuntamente la relación de ansiedad y depresión en la adherencia analgésica (efecto negativo alto 39,1 % vs. efecto negativo bajo 8,3 %, p = 0,013). Se encontró que las estrategias de afrontamiento activas se asociaban con infrauso (OR = 1,132, IC 95 %: 1,027-1,249, p = 0,013) y las pobres estrategias de afrontamiento se relacionaron con un mal uso de los opioides (p = 0,01)...(AU)

Introduction: The lack of adherence is frequent in chronic pain (CP) patients and the influence of psychological factors may play a relevant role. The aim of this study was to analyze the psychological factors related to the adherence to analgesic treatment in patients with CP. Methodology: A systematic review was carried out, including original articles published in English and Spanish between June-2009 and June-2019 included in Pudmed, Scopus, Web of Science and PsycINFO. Articles with cross-sectional and longitudinal design were included, carried out in a population >18 years with chronic non-oncological pain (CNOP) and that analyzed any psychological variable in relation to adherence to analgesic treatment. The search terms were "adherence", "compliance", "misuse", "analgesic", "chronic pain" and "psychology". The quality of the articles included was analysed through the Critical Appraisal Checklist for Analytical Cross-sectional studies of Joanna Briggs Institute for cross-sectional studies and the Newcastle-Ottawa Quality Assessment Form for Cohort Studies for the longitudinal studies. Results: A total of 1184 articles were initially identified, and 14 were finally selected. Depression was the most studied variable, being included in 11 articles, fo­­llowed by anxiety, that appeared in 6. Both depression and anxiety were repeatedly associated with lo­­wer adhe­rence to analgesic treatment, and the same was true in two of the articles that measured jointly the relationship of anxiety and depression on analgesic adherence (high negative affect 39.1 % vs. low negative affect 8,3 %, p = 0.013). Active coping strategies were found to be associated with underuse (OR = 1.132, 95 % CI: 1.027-1.249, p = 0.013) and poor coping strategies were associated with opioid misuse (p = 0.01)...(AU)

Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

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Problemas éticos en el manejo del dolor. Estudio cualitativo mediante entrevista de reflexión abierta / Ethical problems in the management of pain. Qualitative study through open reflection interview

INTRODUCCIÓN: La práctica médica en el área del dolor plantea problemas éticos en la atención a pacientes con una enfermedad que provoca un deterioro funcional, con un pronóstico incierto para su reinserción laboral, y gran consumo de recursos familiares y sociales. Tras la creación de un grupo de trabajo en bioética dentro de la Sociedad Española del Dolor (SED) se intenta analizar dichos problemas. OBJETIVO: Conocer los problemas éticos relacionados con el manejo del dolor (práctica clínica, entorno e instituciones) que preocupan a los profesionales miembros de la SED, así como fomentar una reflexión ética. METODOLOGÍA: Estudio cualitativo, basado en una entrevista semiestructurada, abierta, enviada a los miembros de la SED (n = 1035), mediante acceso electrónico, sobre 4 aspectos bioéticos: los problemas detectados en la práctica clínica, los problemas del entorno de trabajo, los problemas en las organizaciones de trabajo, y posibles sugerencias. Estos se agrupan según se refieran a las indicaciones (beneficencia y no maleficencia), la justicia (entendida como equidad) o la autonomía (información y preferencias). RESULTADOS: Participaron en la entrevista un 6 % de los profesionales (n = 62/1035). Se elaboró un panel con las 10 cuestiones principales identificadas. Destacan la incertidumbre en la toma de decisiones en la terapéutica, la limitación del esfuerzo terapéutico, los condicionamientos del sistema sanitario, las relaciones con la industria farmacéutica y la búsqueda de la excelencia. CONCLUSIONES: Este estudio cualitativo permite identificar problemas éticos que interesan a los profesionales dedicados al dolor. Es conveniente confirmarlos y dimensionarlos mediante estudios cuantitativos

INTRODUCTION: The medical practice in the area of pain associates ethical problems in the care of patients with a disease that causes a functional deterioration, with an uncertain prognosis for their labor reintegration, and a great consumption of family and social resources. After the creation of a working group on bioethics within the Spanish Pain Society (SPS), an attempt is made to analyze these problems. OBJECTIVE: To know which are the ethical problems that identify professionals (clinical practice, environment and institutions) which concerns SPS members; encouranging an ethical reflection. METHODOLOGY: Qualitative study, based on a semistructured, open interview, send to members of the SPS (n = 1035), through electronic access, on 4 bioethical aspects: the problems detected in clinical practice, the problems of the work environment, the problems in the work organizations, and possible suggestions. These are grouped as they refer to the indications (beneficence and non-maleficence), justice (understood as equity), autonomy (information and preferences). RESULTS: A total of 6 % professionals participated in the interview (n = 62/1035). A panel was prepared with the 10 main issues identified. They emphasize the uncertainty in the taking of decisions in the therapeutic, the limitation of the therapeutic effort, the conditioning of the sanitary system, the relations with the pharmaceutical industry and the search of the excellence. CONCLUSIONS: This qualitative study allows identifying ethical problems that interest professionals dedicated to pain. It is convenient to confirm and size them through quantitative studies

Dup-24 bp in the CHIT1 Gene in Six Mexican Amerindian Populations.

Chitotriosidase (CHIT, EC 3.2.1.14) is an enzyme secreted by activated macrophages with the ability to hydrolyze the chitin of pathogens. The high activity of this enzyme has been used as a secondary biomarker of response to treatment in patients with Gaucher disease (OMIM 230800). Within the world's population, approximately 6% is homozygous and 35% is heterozygous for the most common polymorphism in the CHIT1 gene, a 24-bp duplication (dup-24 bp), with homozygosity of this duplication causing inactivation of the enzyme but without major consequences for health. To determine the frequency of the dup-24 bp CHIT1 gene in indigenous populations from Mexico, 692 samples were analyzed: Purepecha (49), Tarahumara (97), Huichol (97), Mayan (139), Tenek (97), and Nahua (213). We found that the groups were in Hardy-Weinberg equilibrium. The dup-24 bp allele frequency was found to be (in order of highest to lowest) 37% (Mayan), 34% (Huichol and Nahua), 33% (Purepecha), 31% (Tenek), and 29% (Tarahumara).

Analysis of serum phospholipid profiles by liquid chromatography-tandem mass spectrometry in high resolution mode for evaluation of atherosclerotic patients.

Atherosclerosis is one of the most frequent etiology for myocardial infarction and death. It is also the main cause of angina pectoris, a perceived symptom that results of a mismatch between myocardial supply and demand, caused by the partial obstruction of the arteries. The correct diagnosis of atherosclerosis can led to a reduction of mortality. In this research, the phospholipids profile of serum samples from patients diagnosed with stable angina and non-ST elevation myocardial infarction (NSTEMI) or unstable angina was obtained by selective solid-phase extraction (SPE) and subsequent LC-QTOF MS/MS analysis in high resolution mode. Comparative statistical analysis allowed finding four potential markers to discriminate between stable angina and NSTEMI/unstable angina: lysoPC(20:5), PC(18:1/18:2), PC(18:0/20:4) and SM(d18:2/14:0). The panel generated by multivariate ROC analysis by combination of the four compounds provided a disease prediction capability in the training set of 70.7 and 66.0% for stable angina and NSTEMI patients, respectively. On the other hand, external validation by application to an independent cohort improved the predictive power for angina stable patients (92.3%), while this was slightly decreased up to 50.0% for NSTEMI/unstable angina patients. In this way, LC-QTOF MS/MS has shown to be a useful strategy for phospholipid profiling in serum and development of tools to aid in clinical diagnostic.

Paciente con síndrome cardiorrenal terminal que no acepta una limitación de esfuerzo terapéutico. Análisis del problema ético-clínico / Terminal cardiorenal syndrome patient not willing to accept a limitation of therapeutic effort. Ethical and clinical problem's analisys

La indicación de limitación de esfuerzo terapéutico en un caso de síndrome cardiorrenal planteó un problema ético en un paciente que solicita ultrafiltración, medida considerada fútil por sus médicos. La consulta al comité de ética asistencial, el análisis ético-clínico y el proceso de comunicación ayudaron a tomar las mejores decisiones

The limitation of therapeutic effort in a cardiorenal syndrome patient asking for ultrafiltration led to an ethical problem. An ethical care committee consultation and communication process helped in making the correct decisions

Sedación paliativa en un Hospital Universitario: experiencia tras la puesta en marcha de un protocolo específico / Palliative sedation in a University Hospital: experience after introducing a specific protocol

Pacientes y métodos. Estudio descriptivo prospectivo del registro de sedación paliativa (SP) durante un año tras la puesta en marcha del protocolo de SP. Criterios de inclusión. Pacientes incluidos en el protocolo de SP del Hospital Universitario Virgen Macarena y para los que se había completado la «Hoja de registro de datos». Fuentes de información. Hojas de registro incluidas en el protocolo de SP como anexo n.° 5, incluidas como anexo 1 en este trabajo. Variables. Datos de filiación, datos relativos a la enfermedad de base, pronóstico, nivel de información. Síntoma refractario: tipo, tiempo de evolución y tratamientos aplicados. Participación del enfermo y/o sus representantes en la toma de decisiones. Tipo de sedación, continuidad, profundidad, fármacos utilizados, duración y resultados y reajuste del resto de medidas terapéuticas. Análisis estadístico. Se analizaron las variables mediante SPSS 14.0: para variables cualitativas se estudiaron frecuencias absolutas y proporciones. Para cuantitativas con distribución normal, medias y desviaciones típicas, y con distribución no normal, medianas y rangos. Resultados. En el periodo del estudio constatamos 90 casos de SP. Ello representa el 27,6% de los pacientes atendidos por el equipo de soporte de cuidados paliativos (ESCP) hospitalario, y el 7,03% de los enfermos fallecidos en el hospital. La edad media de los pacientes tratados con SP fue de 59,22 años y rango entre 40,86 y 77,58 años. Un 68,1% fueron hombres. Todos se encontraban en fase avanzada o terminal de su enfermedad, y el 49,5% en fase agónica. En el 90,4% de los casos la patología fundamental fue oncológica. Respecto a la indicación de SP, esta fue realizada de manera conjunta por el médico del ESCP y su médico responsable en 60 casos (66,6%); Los síntomas que motivaron la sedación fueron mayoritariamente: disnea, delirium y dolor. En 5 casos se consultó al Comité de Ética Asistencial. La duración media de la sedación fue de 134,02 h (5,5 días). En el 90% de los casos, la duración osciló entre 50 y 218,04 h (2-9 días). La profundidad de la SP, tras inducción, quedó registrada en el 88,8% de los casos. El consentimiento informado (CI) fue explícito en el 11,2%, otorgado antes de presentar síntomas refractarios y/o fase agónica. En el 88,8% de las sedaciones el CI fue por representación. Respecto a los fármacos empleados como opción inicial, fue midazolam en el 87,8%, y levomepromacina en el 10,2%. Hasta un 15% de sedaciones precisaron cambio o asociación de fármacos. Conclusión. 1) La aplicación de un protocolo de SP y la disponibilidad del ESCP hospitalario y el Comité de Ética asistencial favorecieron el uso seguro (correcto) de la SP en un hospital sin unidad de cuidados paliativos (UCP), y el registro homogéneo de datos para su análisis, con criterios de calidad similares a los que ofrece una UCP. 2) Hemos detectado áreas de mejora que se aplicarán en la segunda versión de nuestro protocolo(AU)

Patients and methods. A descriptive prospective study of palliative sedation (PS) records during a one year period after starting the PS protocol. Inclusion criteria. Patients included in the PS protocol and those who had completed the «data registry form». Data sources. Registry forms included in the PS protocol as Annex 5 (included as Annex 1 in this study). Variables. Personal data, data regarding basal disease, prognosis, level of information. Refractory symptoms: type, time of evolution and treatments employed. Involvement of the patient and/or representatives in decision making. Type of sedation, continuity, depth, employed, duration and results, and readjustment of other therapeutic measures. Statistical analysis. The SPSS 14.0 was used. For qualitative variables we studied absolute frequencies and proportions. For quantitative variables with normal distribution, we used means and standard deviations, and for non-normal distribution, medians and ranges. Results. In the study period 90 cases of PS were counted. This represented 27.6% of the patients treated in the hospital palliative care support team (PCST), and 7.03% of the total deceased patients in our hospital. Mean age of patients undergoing PS was 59.22 years old, range between 40.86 and 77.58 years, and 68.1% were men. All patients were in an advanced or terminal stage of their condition, and 49.5% in an agonal phase. In 90.4% of the cases, the main pathology was oncological. Regarding PS indication, this was jointly made between the PCST physician and the patient's usual doctor in 60 cases (66.6%). Symptoms leading to sedation were mainly dyspnea, delirium and pain. The Ethics committee was consulted in five cases. Mean time under sedation was 134.02 hours (5.5 days). In 90% of the cases, duration ranged from 50 to 218.04 hours (2-9 days). Depth of PS after induction was registered in 88.8% of the cases. Informed consent (IC) was explicit in 11.2% of the cases,and given prior to the appearance of refractory symptoms and/or agonal phase. In 88.8% of sedation cases, the IC was given by a representative. Midazolam was the most used drug of choice in 87.8% of the cases, and levomepromazine in 10.2%. Up to 15% of sedations required drug changes or combinations. Conclusion. 1) The application of a PS Protocol and the availability of a hospital PCST and an Ethical Care Committee favored a safe (correct) use of PS in a hospital lacking a palliative care unit (PCU), and a homogeneous data registry for their analysis, with quality criteria similar to those offered by a PCU. 2) We have detected areas of improvement that will be applied in the second version of our protocol(AU)

[Palliative sedation in a university hospital: experience after introducing a specific protocol]. / Sedación paliativa en un Hospital Universitario: experiencia tras la puesta en marcha de un protocolo específico.

PATIENTS AND METHODS: A descriptive prospective study of palliative sedation (PS) records during a one year period after starting the PS protocol. INCLUSION CRITERIA: Patients included in the PS protocol and those who had completed the "data registry form". DATA SOURCES: Registry forms included in the PS protocol as Annex 5 (included as Annex 1 in this study). VARIABLES: Personal data, data regarding basal disease, prognosis, level of information. Refractory symptoms: type, time of evolution and treatments employed. Involvement of the patient and/or representatives in decision making. Type of sedation, continuity, depth, employed, duration and results, and readjustment of other therapeutic measures. STATISTICAL ANALYSIS: The SPSS 14.0 was used. For qualitative variables we studied absolute frequencies and proportions. For quantitative variables with normal distribution, we used means and standard deviations, and for non-normal distribution, medians and ranges. RESULTS: In the study period 90 cases of PS were counted. This represented 27.6% of the patients treated in the hospital palliative care support team (PCST), and 7.03% of the total deceased patients in our hospital. Mean age of patients undergoing PS was 59.22 years old, range between 40.86 and 77.58 years, and 68.1% were men. All patients were in an advanced or terminal stage of their condition, and 49.5% in an agonal phase. In 90.4% of the cases, the main pathology was oncological. Regarding PS indication, this was jointly made between the PCST physician and the patient's usual doctor in 60 cases (66.6%). Symptoms leading to sedation were mainly dyspnea, delirium and pain. The Ethics committee was consulted in five cases. Mean time under sedation was 134.02 hours (5.5 days). In 90% of the cases, duration ranged from 50 to 218.04 hours (2-9 days). Depth of PS after induction was registered in 88.8% of the cases. Informed consent (IC) was explicit in 11.2% of the cases,and given prior to the appearance of refractory symptoms and/or agonal phase. In 88.8% of sedation cases, the IC was given by a representative. Midazolam was the most used drug of choice in 87.8% of the cases, and levomepromazine in 10.2%. Up to 15% of sedations required drug changes or combinations. CONCLUSION: 1) The application of a PS Protocol and the availability of a hospital PCST and an Ethical Care Committee favored a safe (correct) use of PS in a hospital lacking a palliative care unit (PCU), and a homogeneous data registry for their analysis, with quality criteria similar to those offered by a PCU. 2) We have detected areas of improvement that will be applied in the second version of our protocol.

Method based on GC-MS to study the influence of tricarboxylic acid cycle metabolites on cardiovascular risk factors.

Metabolites involved in the tricarboxylic acid (TCA) cycle have previously been proposed as cardiovascular biomarkers. This cycle plays a key role in cell metabolism and the levels of the involved metabolites can also be affected by other physiological factors. The influence of three cardiovascular risk factors such as obesity, hypercholesterolemia, and smoking habit on serum levels of TCA-cycle metabolites has been studied in patients diagnosed with significant coronary lesion. For this purpose, a method based on GC-MS for determination of the target metabolites (viz. citric/isocitric, pyruvic, aconitic, oxaloacetic, malic, fumaric and succinic acids) in serum has been developed. The high accuracy and throughput analysis featuring the method have allowed application to a cohort of 223 patients, 172 of them with significant coronary lesion. Multifactor analysis of variance has revealed interactions between the occurrence or not of a coronary lesion and the risk factors considered in this study. These interactions were crucial to explain the levels of target TCA metabolites. Statistical evaluation by ROC curves allowed discrimination of the capability of significant metabolites with the occurrence of coronary lesions.

Determination of essential amino acids in human serum by a targeting method based on automated SPE-LC-MS/MS: discrimination between artherosclerotic patients.

An automated method based on a hyphenated SPE-LC-MS/MS configuration has been optimized for the determination of essential amino acids (threonine, valine, methionine, leucine, isoleucine, lysine, tryptophan, and phenylalanine) in human serum, with the aim of discriminating between different states of coronary artery disease. Validation in terms of sensitivity (detection limits below 28.0 ng on column) and precision (repeatability expressed as relative standard deviation below 6.0%) supports the suitability of the method for application to a cohort of 122 atherosclerosis patients confirmed by a catheterization test. The cohort was composed by 80 individuals diagnosed with stable angina and 42 patients who suffered from acute myocardial infarction (AMI). Both groups of individuals are differentiated by the occurrence of ischemia in AMI patients due to the formation of thrombi. The chemometric treatment of the data obtained by multivariate analysis of variance (MANOVA) allowed comparison between both groups of diagnosed patients. Therefore, amino acids whose serum levels were affected by ischemia have been identified. The contribution of risk factors such as obesity and hypercholesterolemia as well as the individuals' gender to the concentration of essential amino acids has also been studied.

Total and organic mercury in ten fish species for human consumption from the Mexican Pacific.

Total mercury and organic mercury were measured in ten fish species from the Mexican Pacific ocean to have a general view on the ratio of total mercury-organic mercury and potential implications on human health. Highest concentration of total mercury was recorded in muscle tissue of Carcharhinus leucas (0.62 µg g⁻¹ wet weight). Organic mercury was more concentrated in Haemulon sexfasciatum (0.4 µg g⁻¹ wet weight). Percentages of organic mercury ranged from 33 to 100%. Hazard indices associated to organic mercury and average fish consumption in Mexico ranged from 0.25 in Lutjanus colorado to 1.65 in Haemulon sexfasciatum.

Revisión bibliográfica de Implantología Bucofacial del año 2008. Segunda parte / Bibliographical review of Oral Implantology of the year 2008. Part two

La actividad asistencial de los profesionales de la Odontología tiene como consecuencia una baja disponibilidad de tiempo para dedicarse a la lectura de artículos científicos. Ante la dificultad de mantener un buen nivel de información en el campo de la Implantología Bucofacial, nuestro intereses exponer de forma sintética una revisión de la literatura científica publicada en las revistas más relevantes de la especialidad durante el año 2008. El lector interesado encontrará en este artículo algunos de los diferentes temas que integran esta disciplina, expuestos por apartados (regeneración ósea guiada, técnicas avanzadas, elevación del suelo del seno maxilar, mini implantes, plasma rico en plaquetas, factores de crecimiento, tejidos blandos y complicaciones) (AU)

The lack of the available time of the professionals involved in the Odontologic field and the difficulty to maintain a good level of information about Oral Implantology, arouses the interest of the authors to expose a synthetic review of the publications. Inside this article there are different aspects related to guided bone regeneration, advanced techniques, sinus lift, mini-implants, platelet rich plasma, growth factors, soft tissues and complications (AU)

Proyecto de 'Ley de Muerte Digna' en Andalucía / No disponible

No disponible

Propuesta sobre las competencias en Anestesiología, Reanimación y Terapéutica del Dolor de un graduado de Medicina. Consenso del profesorado de las universidades de Cataluña / No disponible

No disponible

Organic and total mercury in muscle tissue of five aquatic birds with different feeding habits from the SE Gulf of California, Mexico.

We measured organic and total Hg in muscle tissue of five species of aquatic birds from the south-eastern gulf of California region, Mexico. Concentrations of total and organic Hg measured in Pelecanus occidentalis were the highest (2.85 and 2.68 microgg(-1)); lowest values of organic Hg (0.20 microgg(-1)) and total Hg (0.47 microgg(-1)) were detected in Anas discors and Anas clypeata, respectively. Differences of Hg levels were related to feeding habits, being concentrations in birds of piscivorous habits more elevated than corresponding values in non-piscivorous species.