COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome.

OBJECTIVE: To assess the impact of corticosteroids on inflammatory and respiratory parameters of patients with COVID-19 and acute respiratory distress syndrome (ARDS). METHODS: Longitudinal, retrospective, observational study conducted in an ICU of a second level hospital. Adult patients with COVID-19 were included. Baseline characteristics, data on SARS-CoV-2 infection, treatment received, evolution of respiratory and inflammatory parameters, and ICU and hospital stay and mortality were analyzed. RESULTS: A total of 27 patients were included, 63% men, median age: 68.4 (51.8, 72.2) years. All patients met ARDS criteria and received MV and corticosteroids. After corticosteroids treatment we observed a reduction in the O2 A-a gradient [day 0: 322 (249, 425); day 3: 169 (129.5, 239.5) p<0.001; day 5: 144 (127.5, 228.0) p<0.001; day 7: 192 (120, 261) p=0.002] and an increase in the pO2/FiO2 ratio on days 3 and 5, but not on day 7 [day 0: 129 (100, 168); day 3: 193 (140, 236) p=0.002; day 5: 183 (141, 255) p=0.004; day 7: 170 (116, 251) p=0.057]. CRP also decreased on days 3 and 5 and increased again on day 7 [day 0: 16 (8.6, 24); day 3: 3.4 (1.7, 10.2) p<0.001; day 5: 4.1 (1.4, 10.2) p<0.001; day 7: 13.5 (6.8, 17.3) p=0.063]. Persistence of moderate ARDS on day 7 was related to a greater risk of poor outcome (OR 6.417 [1.091-37.735], p=0.040). CONCLUSIONS: Corticosteroids appears to reduce the inflammation and temporarily improve the oxygenation in COVID-19 and ARDS patients. Persistence of ARDS after 7 days treatment is a predictor of poor outcome.

Vascular angiotensin AT1 receptor neuromodulation in fetal programming of hypertension.

Fetal stress increases the susceptibility to cardiovascular diseases in adult age, including hypertension, a process known as fetal programming of hypertension (FPH). This study intends to investigate the interplay between vascular sympathetic nervous system (SNS) and RAS, namely the neuromodulatory role exerted by Angiotensin II (Ang II) receptor-1 (AT1) in FPH, and respective contribution for hypertension. METHODS: 6-month old Sprague-Dawley offspring from mothers fed ad-libitum (CONTROL) or with 50% intake during the second half of gestation (maternal undernutrition, MUN) were used. Sympathetic neurotransmission was studied in mesenteric/tail arteries and mesenteric veins by electrically-evoked [3H]-noradrenaline release experiments using RAS drugs. AT1 receptors in sympathetic nerves of mesenteric arteries were investigated by immunohistochemistry and Laser Scanning Confocal Microscopy. RESULTS: Ang II facilitated noradrenaline release in the vessels studied from MUN and CONTROL rats. Losartan induced a tonic facilitation only in MUN vessels. Sympathetic innervation was larger in MUN versus CONTROL vessels. AT1 receptors on sympathetic nerves were present in higher amounts in MUN versus CONTROL vessels. CONCLUSIONS: Findings support that FPH is associated with a vascular hyper-sympathetic activation, involving a tonic facilitation of prejunctional AT1 receptors by endogenous Ang II, which can justify, at least in part, the development of hypertension.

Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico / Mortality in obesity-hypoventilation syndrome and prognostic risk factors

No disponible

Effect of fetal undernutrition and postnatal overfeeding on rat adipose tissue and organ growth at early stages of postnatal development.

Intrauterine and perinatal life are critical periods for programming of cardiometabolic diseases. However, their relative role remains controversial. We aimed to assess, at weaning, sex-dependent alterations induced by fetal or postnatal nutritional interventions on key organs for metabolic and cardiovascular control. Fetal undernutrition was induced by dam food restriction (50 % from mid-gestation to delivery) returning to ad libitum throughout lactation (Maternal Undernutrition, MUN, 12 pups/litter). Postnatal overfeeding (POF) was induced by litter size reduction from normally fed dams (4 pups/litter). Compared to control, female and male MUN offspring exhibited: 1) low birth weight and accelerated growth, reaching similar weight and tibial length by weaning, 2) increased glycemia, liver and white fat weights; 3) increased ventricular weight and tendency to reduced kidney weight (males only). Female and male POF offspring showed: 1) accelerated growth; 2) increased glycemia, liver and white fat weights; 3) unchanged heart and kidney weights. In conclusion, postnatal accelerated growth, with or without fetal undernutrition, induces early alterations relevant for metabolic disease programming, while fetal undernutrition is required for heart abnormalities. The progression of cardiac alterations and their role on hypertension development needs to be evaluated. The similarities between sexes in pre-pubertal rats suggest a role of sex-hormones in female protection against programming.

Características de los pacientes con hipertensión pulmonar tromboembólica crónica atendidos en una consulta específica de hipertensión pulmonar / No disponible

La hipertensión pulmonar tromboembólica crónica (HPTEC) es una complicación a largo plazo de la embolia pulmonar sintomática, con una incidencia acumulada del 1-5% en los 2 años siguientes al episodio. Además, alrededor del 40% de los casos tiene su origen en un tromboembolismo venoso asintomático. En estos casos se recomienda la administración de anticoagulación oral a largo plazo. No obstante, hay que tener en cuenta que el único tratamiento curativo es la tromboendarterectomía. Para los pacientes no candidatos a cirugía, con malos resultados tras la misma, o como puente antes de la intervención, está indicado el tratamiento médico. El fármaco más estudiado en esta enfermedad es el bosentán, que ha demostrado que mejora significativamente la resistencia vascular pulmonar y el índice cardíaco. En este artículo se analizan los diferentes tipos de tratamiento disponibles en la actualidad, mediante el análisis de seis casos de HPTEC atendidos en una consulta específica durante un periodo de 2 años (AU)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication of symptomatic pulmonary embolism, with an incidence of 1-5% in the two years following the episode. In addition, about 40% of cases stems from asymptomatic venous thromboembolism. In these cases we recommend the administration of long-term oral anticoagulation. However, we must bear in mind that the only curative treatment is thromboendarterectomy. For patients who are not candidates for surgery, with poor results after the same, or as a bridge before surgery, medical treatment is indicated. The most studied drug in this disease is the bosentan, which has shown to significantly improve pulmonary vascular resistance and cardiac index. This article discusses the different types of treatment available today, through the analysis of six cases of CTEPH treated in a separate consultation for a period of two years (AU)

Enfermedad pulmonar venooclusiva en una mujer jardinera / No disponible

La enfermedad pulmonar venooclusiva (EPVO) es una forma infrecuente de hipertensión arterial pulmonar, con un pronóstico sombrío. El diagnóstico suele ser tardío y el único tratamiento curativo en la actualidad es el trasplante pulmonar. Presentamos el caso de una mujer jardinera de 51 años, cuyo diagnóstico se obtuvo por biopsia pulmonar abierta realizada previamente a su fallecimiento. Si bien existen casos reportados de enfermedad pulmonar venooclusiva hepática secundaria a agentes tóxicos presentes en la naturaleza, como el alcaloide pirrolizidina, hasta el momento no se han relacionado con la enfermedad a nivel pulmonar (AU)

Pulmonary veno-occlusive disease (PVOD) is a subgroup of pulmonary arterial hypertension with a poor prognosis. The diagnosis is usually delay and treatment options other lung transplation are unfortunately limited. We report the case of gardener 51 year old woman diagnosed with PVOD by open lung biopsy before her death. There are any cases report of hepatic veno-occlusive disease due to nature, like “pyrrolizidine alkaloid” exposure, but this is not proven to PVOD (AU)

Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias / Unsuspected pulmonary thromboembolism in the Emergency Department

Antecedentes y objetivos. El tromboembolismo pulmonar (TEP) es una enfermedad que en ocasiones, se diagnostica con un elevado retraso, lo que puede provocar una mayor morbimortalidad. Hemos definido el perfil clínico de los pacientes con TEP no sospechado en el Servicio de Urgencias, y los factores que influyen en el retraso para establecer el diagnóstico de TEP. Pacientes y métodos. Se analizaron retrospectivamente 148 pacientes ingresados con diagnóstico de TEP confirmado mediante TAC (n=133) o gammagrafía de ventilación/perfusión de alta probabilidad (n=15). Fueron divididos en dos grupos: los que no tenían sospecha diagnóstica de la enfermedad en el Servicio de Urgencias (TEP no sospechado) y aquellos en los que sí se sospechó este proceso (TEP sospechado). Se estudiaron las características clínicas, los factores de riesgo, los signos y los síntomas a su llegada a Urgencias; las pruebas complementarias realizadas, los días de ingreso hospitalario y la mortalidad. Resultados. De los 148 enfermos con TEP, el diagnóstico no se sospechó en el Servicio de Urgencias en 63 pacientes (42,6%). La disnea y el dolor torácico fueron las manifestaciones clínicas más comunes y se identificaron con mayor frecuencia entre los enfermos con TEP sospechado, que entre los pacientes con TEP no sospechado, con diferencias significativas (OR=0,4 [0,2-0,9] para la disnea y OR=0,3 [0,2-0,7], para el dolor torácico). Sin embargo, la presencia asociada de trombopenia (OR=3,4 [1,1-10,2], p<0,05), un electrocardiograma (ECG) normal (OR=3,4 [1,1-10,2], p<0,05), y la localización del TEP en pulmón derecho (OR=4,7 [2-11,3], p<0,001), fueron factores asociados a la no sospecha de la enfermedad. Los días de ingreso y de duración de los síntomas, así como la mortalidad, no fueron estadísticamente diferentes entre ambos grupos. Conclusiones. La proporción de enfermos con TEP confirmado pero no sospechado en el Servicio de Urgencias fue elevada (cerca del 40%). La presencia de disnea y dolor torácico se asociaron a la sospecha de TEP. Por el contrario, la presencia de trombopenia, un ECG normal, y la localización del TEP en el pulmón derecho se asociaron a la no sospecha de TEP en urgencias(AU)

Background and objectives. Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. Patients and methods. A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. Results. The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. Conclusions. According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department(AU)

[Unsuspected pulmonary thromboembolism in the Emergency Department]. / Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias.

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. PATIENTS AND METHODS: A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. RESULTS: The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. CONCLUSIONS: According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department.

Excitotoxic stimulus stabilizes PFKFB3 causing pentose-phosphate pathway to glycolysis switch and neurodegeneration.

6-Phosphofructo-2-kinase/fructose-2,6-bisphosphatase-3 (PFKFB3) is a master regulator of glycolysis by its ability to synthesize fructose-2,6-bisphosphate, a potent allosteric activator of 6-phosphofructo-1-kinase. Being a substrate of the E3 ubiquitin ligase anaphase-promoting complex-Cdh1 (APC(Cdh1)), PFKFB3 is targeted to proteasomal degradation in neurons. Here, we show that activation of N-methyl-D-aspartate subtype of glutamate receptors (NMDAR) stabilized PFKFB3 protein in cortical neurons. Expressed PFKFB3 was found to be mainly localized in the nucleus, where it is subjected to degradation; however, expression of PFKFB3 lacking the APC(Cdh1)-targeting KEN motif, or following NMDAR stimulation, promoted accumulation of PFKFB3 and its release from the nucleus to the cytosol through an excess Cdh1-inhibitable process. NMDAR-mediated increase in PFKFB3 yielded neurons having a higher glycolysis and lower pentose-phosphate pathway (PPP); this led to oxidative stress and apoptotic neuronal death that was counteracted by overexpressing glucose-6-phosphate dehydrogenase, the rate-limiting enzyme of the PPP. Furthermore, expression of the mutant form of PFKFB3 lacking the KEN motif was sufficient to trigger oxidative stress and apoptotic death of neurons. These results reveal that, by inhibition of APC(Cdh1), glutamate receptors activation stabilizes PFKFB3 thus switching neuronal metabolism leading to oxidative damage and neurodegeneration.

Fat intake and asthma in Spanish schoolchildren.

OBJECTIVES: To study the relationship between lipid, fatty acid and lipid-rich food intake and current asthma in a group of Spanish schoolchildren. SUBJECTS/METHODS: The subjects of this cross-sectional study were 638 Spanish schoolchildren (8-13 years of age). The weight and height of all the subjects were recorded. A questionnaire, completed by the subjects' parents, was used to obtain personal and health information. Current asthma was established when the children had ever had asthma, if they had been diagnosed with asthma by a doctor and if they had been treated with medications at some time in the previous 12 months. Food intake was monitored using a 3-day food record. All foods consumed were converted into energy and nutrients. RESULTS: The energy derived from lipids, saturated fatty acids (SFAs) and myristic and palmitic acids was independently associated with current asthma (Odds Ratio (OR) third tertile 2.85 (1.01-8.07) P=0.049, 10.00 (0.89-111.97) P=0.002, 11.21 (1.36-92.24) P=0.002, 7.58 (1.40-41.03) P=0.022, respectively), as was the intake of butter (OR third tertile 2.97 (1.01-8.68) P=0.001). No relationship was seen between this condition and the intake of any other fatty acid, the n-6/n-3 ratio, nor the consumption of margarine, milk products, fish, meat, eggs or vegetable oils. CONCLUSIONS: Increased intakes of SFAs, myristic and palmitic acids and butter seem to be related to the risk of current asthma in children.

«Saber envejecer. Prevenir la dependencia.» Un modelo para el diseño de materiales didácticos / «Knowing how to age and prevent dependency». A model for the design of didactic materials

El presente artículo aborda un proyecto de investigación-acción basado en metodología cualitativa con el propósito de fomentar un envejecimiento activo y exitoso, además de prevenir las situaciones de dependencia. Los objetivos básicos son: procurar información a las personas mayores sobre los aspectos que determinan un envejecimiento activo y saludable; dotar a las personas mayores de las habilidades necesarias para prevenir las situaciones de dependencia y lograr un envejecimiento satisfactorio; promover la autonomía de las personas mayores con discapacidad; facilitar a los profesionales de la salud y los servicios sociales herramientas para conseguir un envejecimiento saludable y prevenir la dependencia, y, finalmente, generar un cambio de actitudes y un pensamiento positivo ante el envejecimiento (AU)

The present article describes a research-action project based on qualitative methodology, which aims to promote active and successful ageing and prevent dependency. The main goals of the project are: to offer information to older adults on the factors leading to active and successful ageing; to provide elderly people with the skills needed to prevent dependency and achieve satisfactory ageing; to promote autonomy in elderly people with disabilities; to supply health and social services professionals with tools to achieve successful ageing and prevent dependency; and to change attitudes and generate positive thinking about ageing (AU)

Prejubilación activa: demandas, necesidades e intereses de las personas prejubiladas de la minería asturiana / Active early retirement: the demands, needs and interests of persons taking early retirement from the mining industry in Asturias (Spain)

Objetivos: detectar y analizar las demandas, necesidades e intereses de las personas prejubiladas de la minería asturiana como consecuencia de su salida anticipada del trabajo. Material y métodos: se desarrollaron 3 líneas de estudio: a) investigación de corte cualitativo dirigida a analizar la jubilación anticipada en Asturias en la que se utilizaron las técnicas de la entrevista en profundidad y el grupo de discusión; b) talleres grupales para prejubilados de la minería, y c) registro de un cuestionario de intereses. Resultados: la prejubilación en la minería presenta aspectos que son vividos de manera muy positiva, como la ganancia en salud y seguridad, pero también aparecen demandas derivadas de la falta de habilidades personales para la planificación de un nuevo ritmo cotidiano, así como de la falta de rol social. Respecto a las necesidades identificadas, unas hacen referencia a una dimensión individual (preparación para afrontar una nueva situación, formación para adquirir habilidades que permitan ocupaciones significativas y saludables) y otras tienen que ver con una dimensión grupal como la necesidad de encuentro colectivo y de roles que impliquen reconocimiento social. Los intereses detectados (formación, ocio y voluntariado) se agrupan en: nuevas tecnologías, comunicación social, apoyo social, artesanía, salud, medio ambiente y tradición. Conclusiones: los procesos de prejubilación deben ir acompañados de una intervención psicosocial de índole preventiva que contemple diferentes aspectos: preparación a la nueva situación, formación en habilidades que permitan ocupaciones significativas y la promoción de hábitos saludables y la canalización de este colectivo hacia actividades sociales de relevancia para la comunidad

Objectives: to detect and analyse the demands, needs and interests of persons taking early retirement from the mining industry in Asturias. Material and methods: three lines of investigation were developed: a) qualitative research to analyse early retirement in Asturias, which employed the techniques of in-depth interview and group discussion, b) group workshops for individuals taking early retirement from the mining industry, and c) a register of a questionnaire about interests. Results: there are certain aspects to early retirement from mining that were viewed as highly positive, for example, better health and safety. However, demands also arise caused by a lack of personal skills to enable reorganisation of a new rhythm of daily life, as well as the absence of a social role. Some of the needs identified were related to the individual (preparation for coping with a new situation, training to acquire skills leading to healthy, meaningful occupation). Others were more at the group level, such as the need for collective meetings and for roles that involve social acknowledgement. The interests detected (training, leisure time and voluntary work) were grouped as follows: new technologies, social communication, social support, handicrafts, health, environment and tradition. Conclusions: early retirement processes should be linked to psychological and social preventive action dealing with issues such as preparation for a new situation, training in skills to enable meaningful occupation and healthy habits, and channelling of this collective towards social activities of significance to the community

El error diagnóstico en el área de ingresos de un hospital de media-larga estancia. Estudio de concordancia diagnóstica / Diagnostic errors in the emergency room of a medium- to long-stay hospital. Study of diagnostic concordance

Objetivo: analizar la concordancia diagnóstica entre el área de ingresos y la planta de hospitalización en un hospital de media-larga estancia. Pacientes y método: se incluyó a todos los pacientes atendidos en el área de urgencias durante un período de 2,5 meses. Los casos se agruparon en 3 niveles: A (diagnóstico coincidente en su totalidad), B (sólo diagnóstico sindrómico coincidente) y C (diagnóstico no coincidente). Para el análisis estadístico se agruparon los pacientes de los grupos A y B frente a los del C. Se analizaron las variables asociadas con el error diagnóstico. Resultados: de los 528 pacientes recogidos se observó una concordancia de nivel A en el 64% de los casos, de nivel B en el 16,3% y de nivel C en el 19,7%. El motivo más frecuente de discrepancia diagnóstica fue una inadecuada valoración clínica en el área de urgencias. La única variable de las estudiadas que se asoció de manera significativa con el error diagnóstico fue la edad avanzada. Conclusiones: dadas las características de los pacientes incluidos, parece aceptable el porcentaje de concordancia obtenido. La edad avanzada puede influir en una mayor probabilidad de error diagnóstico y es fundamental una adecuada valoración clínica para intentar minimizarlo

Objective: to evaluate the diagnostic concordance between the emergency service and hospitalisation ward in a medium-to long-stay hospital. Patients and method: all patients attended in the emergency service over a 2.5-month period were included in the study. We used a three-level concordance classification system: A (complete diagnostic match), B (syndromal concordance) and C (error). For the statistical analysis we grouped the patients into two categories (A + B and C) and studied the variables associated with erroneous diagnoses. Results: a total of 528 patients were included. We found 64% of patients in level A, 16.3% in level B and 19.7% in level C. The most frequent cause of errors was inadequate clinical evaluation in the emergency room. Old age was the sole variable significantly associated with errors.Conclusions: bearing in mind the characteristics of our patients, the overall concordance seems to be acceptable. Old age can influence a higher likelihood of diagnostic error and consequently thorough clinical evaluation is essential to try to minimise it

«Rompiendo Distancias»: un programa integral para prevenir y atender la dependencia de las personas mayores en el medio rural / «Breaking barriers»: an integral programme to prevent dependency and provide services for elderly individuals in rural areas

Introducción y objetivos: las personas mayores que viven en contextos rurales tienen necesidades específicas que se derivan del tipo de hábitat y de la insuficiencia e inadecuación de servicios que se ubican en ellos. En el Principado de Asturias, una gran parte del territorio está marcado por la ruralidad y por características orográficas que dificultan la participación social y el acceso a los servicios. En este artículo se describen y presentan los resultados de la evaluación de un programa integral para las zonas rurales de Asturias que pretende promocionar el envejecimiento activo, la creación de nuevos servicios de proximidad para prevenir y atender situaciones de dependencia y el incremento del compromiso social. Población y método: rompiendo Distancias se implantó, como iniciativa piloto de carácter innovador, en 3 territorios rurales en los que viven 9.427 personas > 65 años. La metodología planteada para la definición de los proyectos se ha inspirado en la IAP (Investigación, Acción y Participación); para la intervención se ha definido como eje el trabajo comunitario, y para la evaluación de los resultados se realizó un diseño que combina técnicas cualitativas (comisiones técnicas de seguimiento, protocolos de evaluación, análisis DAFO) con técnicas cuantitativas (encuestas a usuarios, familias y profesionales, con la aplicación de 684 cuestionarios, cuyos resultados fueron tratados con el paquete estadístico SPSS). Resultados: en todos los territorios se han creado nuevos servicios de proximidad (transporte accesible, préstamo de ayudas técnicas, servicio de acompañamiento, comida a domicilio, biblioteca móvil, podología, edición de periódicos, etc.) que constituyen iniciativas muy innovadoras. Se han creado 9 asociaciones y sus respectivos centros sociales. Se desarrollan de manera estable actividades culturales, encuentros, programas intergeneracionales e iniciativas de voluntariado. Participaron en el programa 3.219 personas mayores, 169 familias y 219 voluntarios. Todos ellos manifiestan un alto grado de satisfacción con las diferentes iniciativas emprendidas y con el desarrollo del Programa en su conjunto. El modelo de intervención, basado en el trabajo comunitario bajo los principios de transversalidad, coordinación y flexibilidad, ha funcionado de manera satisfactoria y ha supuesto una implicación intersectorial muy significativa. Conclusiones: se ha mostrado la idoneidad del trabajo en red y el enfoque comunitario de la intervención, al que es pertinente que se regrese desde los servicios sociales municipales. En cuanto a los objetivos propuestos, se han cumplido suficientemente con el desarrollo del programa: se ha impulsado la participación social de un grupo de personas mayores que estaban aisladas y desvinculadas socialmente, y se han establecido cauces que aseguran su continuidad. Se han creado nuevos servicios de proximidad y se han mejorado los existentes para mantener la autonomía de muchas personas y apoyar a las familias cuidadoras. Se ha mejorado el capital social a través del movimiento asociativo, el altruismo y los intercambios intergeneracionales

Introduction and objectives: elderly individuals living in rural areas have specific needs derived from their environment and the scarcity of resources available in these locations. A large part of Asturias, in Spain, is rural and its orographic characteristics hamper social participation and access to services. The present article presents the results of evaluation of an integral programme for rural areas in Asturias that aims to promote active ageing, the creation of new and nearby services to prevent and manage dependency and to increase social participation. Population and method: breaking barriers, an innovative pilot project, was implemented in three rural areas with 9427 individuals aged more than 65 years old. The methodology was inspired in Research, Action and Participation (RAP). Work in the community was defined as the axis of the project and a design combining qualitative techniques (technical review committees, evaluation protocols, strengths, weaknesses, opportunities and threats [SWOT] analysis) with quantitative techniques (surveys of users, families and health professionals, with the application of 684 questionnaires and analysis of the results using the SPSS statistical programme) was used to evaluate the results. Results: in all territories new services were created (accessible transport, provision of technical supports, escort service, home meals service, mobile library, podology, newspaper delivery, etc.), which represented highly innovative initiatives. New associations with their respective community centres were created. Cultural activities, meetings, intergenerational programmes and voluntary initiatives were established. A total of 3219 elderly individuals, 169 families and 219 volunteers participated in the programme. All participants showed a high degree of satisfaction with the various initiatives implemented and with the development of the programme as a whole. The model of the intervention, based on community work guided by the principles of a cross-sector approach, coordination and flexibility has worked satisfactorily and has led to significant intersectorial involvement. Conclusions: the utility of the network system established and the community focus of the intervention, to which we recommend that municipal social services return, has been demonstrated. The intervention has also achieved its objective: social participation has been fomented among a group of elderly, physically and socially isolated individuals and channels to ensure the continuity of participation have been established. New, accessible services have been created and existing services have been improved to maintain the autonomy of many individuals and to support caretaking families. Social capital has improved through associations, altruism and intergenerational interchange

[Immunological study of cerebrospinal fluid using a human IgM antiserum produced in Cuba. A preliminary evaluation]. / Estudio inmunológico del líquido cefalorraquídeo con el empleo de un antisuero de IgG humano producido en Cuba. Evaluación preliminar.

INTRODUCTION: The immunological study of cerebrospinal fluid (CSF) is an essential diagnostic tool for evaluating patients with neurological diseases. The quantitative determination of the albumen and immunoglobulin G (IgG) in blood serum and in CSF by single radial immunodiffusion (SRID), together with the calculation of the IgG index to evaluate the presence of intrathecal synthesis of IgG and of the albumen quotient in order to evaluate the state of functioning of the blood brain barrier are essential elements to be evaluated for diagnosis and research in neurological clinical practice, as well as in the follow up of certain neurological diseases such as multiple sclerosis. Specific antiserums from commercial firms such as Boehring, SIGMA, etc. are used for the quantitative determination of IgG and albumen both in blood serum and in CSF by SRID. The high cost and the difficulty in acquiring these immunodiagnostic kits have had an important effect on the diagnostic and research opportunities throughout the country. MATERIALS AND METHODS: In this work we present the preliminary findings of the evaluation of the human IgG antiserum obtained from a ram, by Labex laboratories, for the quantitative determination of IgG in CSF by SRID, in order to find out whether this antiserum is efficient in the quantitative determination of IgG in CSF. RESULTS AND CONCLUSIONS: The studies conducted so far show that this antiserum may be a good candidate for use in immunological studies of CSF. Further work needs to be carried out on its validation in order to resolve the problems involved in immunological studies of CSF that we highlighted above. This would be achieved with an antiserum that is cheaper than those used up to now.