COVID-19 impact on nurses in Spain: a considered opinion survey.

AIM: To survey nurses' opinions about their work conditions at the onset of the COVID-19 pandemic in Spain. BACKGROUND: For the Spanish General Council of Nursing (the Consejo General de Enfermería de España), it was essential to have information on nursing workforce conditions and nurses' preparedness to wear protective measures at the pandemic's onset. The coronavirus outbreak was believed to have started in China and rapidly spread as a global pandemic requiring policies and actions for planning emergency healthcare delivery. METHODS: A cross-sectional survey was conducted online. Data were collected during April 2020 and covered social demography, working conditions, training, availability of personal protective equipment, and nurses' health conditions, including the impact of COVID-19. FINDINGS: From all national territories in Spain, 11 560 registered nurses from different services completed the questionnaire. Findings indicated that the lack of personal protective equipment was a crucial issue, as well as service planning and organization, and 80.2% reported high or very high psychological impact of COVID-19. Alarmingly, 29.5% of the nurses reported COVID-19 symptoms. Of these 23.3% had been tested, and 30.2% were confirmed as being positive to the virus. The nurses deemed proper preparedness for emergencies and disasters as a significant concern. CONCLUSION: Nurses' responses showed evidence of health services deficiencies as a source of damage to their capacity to provide safe patient care and protect themselves and their families' health. The working conditions of the nurses are at critical levels and are unacceptable. The study results provide evidence regarding the necessity of suitable planning and actions being taken to enable safe patient care and safety for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our survey gathered nurses' views at the pandemic's onset. The evidence gathered is being used to advise policymakers and nursing organizations to take actions to control public health risks to populations. It is necessary that more investment in growing nursing workforce expertise and health infrastructure for pandemic and epidemic emergencies is provided.

Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum ß-lactamase-producing Enterobacteriaceae.

PURPOSE: There are few data in the literature regarding sepsis or septic shock due to extended-spectrum ß-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS: Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS: 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. ß-lactam/ß-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS: BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.

Hemorragia obstétrica masiva en una paciente con placenta pércreta / Massive obstetric haemorrhage in a patient with placenta percreta

Presentamos el caso de una paciente de 38 años con diagnóstico prenatal de placenta previa. Al iniciar la cesárea programada se evidenció una placenta pércreta. Tras un sangrado masivo incoercible a pesar de haberse realizado una histerectomía de urgencia, fue necesario embolizar los vasos mediante radiología intervencionista, evolucionando posteriormente sin incidencias(AU)

We present a case of a 38 year-old patient with prenatal diagnosis of placenta praevia. When the elective caesarean began it was found a placenta accreta. In spite of an emergency hysterectomy, embolisation using interventional radiography was needed after a massive obstetric haemorrhage. The post-operative period progressed without incidents(AU)

[Massive obstetric haemorrhage in a patient with placenta percreta]. / Hemorragia obstétrica masiva en una paciente con placenta pércreta.

We present a case of a 38 year-old patient with prenatal diagnosis of placenta praevia. When the elective caesarean began it was found a placenta accreta. In spite of an emergency hysterectomy, embolisation using interventional radiography was needed after a massive obstetric haemorrhage. The post-operative period progressed without incidents.

[Acute transverse myelitis in seven patients with systemic lupus erythematosus]. / Mielitis transversa aguda en siete pacientes con lupus eritematoso sistémico.

INTRODUCTION: Although the association between transverse myelitis and systemic lupus erythematosus is rather infrequent, it is important to take this form of clinical presentation into account because it is a serious complication, which can potentially be treated but even when dealt with in the early stages does not always have a good prognosis. PATIENTS AND METHODS: We conducted a retrospective review over the past 13 years of the cases that have been admitted to our specific centre for the treatment of spinal cord injuries that were diagnosed as suffering from myelitis associated with disseminated lupus erythematosus. Demographic and clinical data, together with data about acute phase and maintenance treatments, as well as the patients' progress and sequelae are described. RESULTS: The case reports of seven patients, all of whom were young females, are studied. In two cases, myelitis was the initial presentation of lupus. The main disorder was at the dorsal, followed by the cervical, levels. Only two patients had a favourable long-term progression from the neurological point of view (both managed to walk) despite acute treatment with high doses of intravenous corticoids, and regardless of the fact that cyclophosphamide was later used. CONCLUSIONS: Myelitis associated to lupus is a rare manifestation but, owing to its important functional repercussions, it must be taken into account when faced with an acute clinical picture involving the spinal cord; this is particularly the case when it occurs in young females, with or without a previous diagnosis of autoimmune disease.

Mielitis transversa aguda en siete pacientes con lupus eritematoso sistémico / Acute transverse myelitis is seven patients with systemic lupus erythematosus

Introducción. Aunque la asociación entre mielitis transversa y lupus eritematoso sistémico es bastante infrecuente, es importante tener en cuenta esta forma de presentación clínica, porque se trata de una complicación grave, con tratamiento potencial, que incluso con intervención temprana no siempre se asocia a un buen pronóstico. Pacientes y métodos. Revisamos de forma retrospectiva durante los últimos 13 años los casos que han ingresado en nuestro centro específico para el tratamientode lesión medular, con diagnóstico de un cuadro de mielitis asociada a lupus eritematoso diseminado. Se describen los datos demográficos, clínicos, el tratamiento realizado en la fase aguda y de mantenimiento, así como su evolución y secuelas.Resultados. Se estudian los casos clínicos de siete pacientes, todas ellas mujeres jóvenes. En dos de ellas la mielitis fue la forma de inicio del lupus. La afectación predominante fue a nivel dorsal y después cervical. Sólo dos pacientes tuvieron una evolución favorable a largo plazo desde el punto de vista neurológico, consiguiendo la deambulación, a pesar del tratamiento agudo con corticoides intravenosos en dosis altas, con independencia de que posteriormente se utilizase ciclofosfamida.Conclusión. La mielitis asociada al lupus es una manifestación infrecuente, pero debe tenerse en cuenta ante un cuadro medular agudo, sobre todo si éste ocurre en mujeres jóvenes, con o sin el diagnóstico previo de la enfermedad autoinmune, debido a su importante repercusión funcional

Introduction. Although the association between transverse myelitis and systemic lupus erythematosus is rather infrequent, it is important to take this form of clinical presentation into account because it is a serious complication, which can potentially be treated but even when dealt with in the early stages does not always have a good prognosis. Patients and methods. We conducted a retrospective review over the past 13 years of the cases that have been admitted to our specific centre for the treatment of spinal cord injuries that were diagnosed as suffering from myelitis associated with disseminated lupuserythematosus. Demographic and clinical data, together with data about acute phase and maintenance treatments, as well as the patients’progress and sequelae are described. Results. The case reports of seven patients, all of whom were young females, are studied. In two cases, myelitis was the initial presentation of lupus. The main disorder was at the dorsal, followed by the cervical, levels. Only two patients had a favourable long-term progression from the neurological point of view (both managedto walk) despite acute treatment with high doses of intravenous corticoids, and regardless of the fact that cyclophosphamide was later used. Conclusions. Myelitis associated to lupus is a rare manifestation but, owing to its important functional repercussions, it must be taken into account when faced with an acute clinical picture involving the spinal cord; this is particularly the case when it occurs in young females, with or without a previous diagnosis of autoimmune disease

Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) with Puerto Rican elderly

The Beck Depression Inventory-Second Edition (BDI-II; (1) is one of the most useful measures for depressive symptomatology in many countries (2). The psychometric properties of this inventory, however, have not been reported with Puerto Rican elderly. This paper reports, exploratory psychometric results with a sample of 410 elderly Puerto Rican (65 years and older; men=94, women=316). The assessment of the construct validity of the BDI-II yielded four factors accounting for 52of total variance and an internal reliability coefficient (alpha Cronbach) of .89. A factor analysis with the 21 items of the BDI-II was performed using principal component analysis as the extraction method and Varimax rotation. This analysis revealed that the BDI-II was a good measure of the dimensions of depressive symptomatology in the present sample, which resembled prior findings reported with the general Puerto Rican Population (3). This study also reports further data supporting the reliability, validity, and practical utility of the BDI-II for the Puerto Rican population including elders. Implications for potential research with minorities and clinical uses of the BDI-II are also discussed.

Humanización en atención urgente. ¿Entendemos lo mismo sanitarios, pacientes y familia? / Humanisation in emergency care. Do health professionals, the patients and their families understand and mean the same thing?

Objetivos: 1.- Determinar el concepto de humanización que tienen los profesionales y los usuarios del sistema. 2. Identificar acciones que mejorarían la humanización, según la población de estudio. 3.- Conocer las prioridades sobre humanización de los grupos de estudio. Método: Se ha realizado un estudio prospectivo transversal utilizando una encuesta semiestructurada, con escalas de Liker del 0 al 10, y recogida de datos durante los meses de Mayo de 2001 y Julio de 2002, dirigida a los profesionales y usuarios del Servicio de Urgencias del Hospital Universitario Ntra. Sra. de Candelaria. La población de estudio estaba compuesta por 64 profesionales, 40 enfermeras y 24 médicos del Servicio de Urgencias, y por 102 usuarios que acudieron al servicio. La recogida de datos fue realizada por el mismo encuestador y en condiciones similares para evitar sesgos. Previamente se pilotaron 12 encuestas a estos efectos. El tratamiento estadístico se realizó con el paquete Rsigma Babel y SPSS. Resultados: El 81 por ciento de los profesionales y el 65 por ciento de los usuarios demandan más información. Para los familiares, un 50 por ciento de respuestas ven como humanizante acompañar a sus parientes enfermos, lo cual sólo opinaba el 14 por ciento de los pacientes. Conclusiones: El concepto de humanización es similar para todos los encuestados: satisfacer a los profesionales y a los usuarios para prestar una atención eficiente, aunque las acciones para conseguirlo dependan de las necesidades, problemas y circunstancias del momento (AU)

Estudio de las características psicométricas del inventario de ansiedad Beck (en castellano) en una muestra de envejecidos puertorriqueños / Psychometric features of the Beck Anxiety Inventory (Spanish version) with a Puerto Rican elderly sample

OBJETIVO: El presente estudio fue diseñado para evaluar las características psicométricas del Inventario de Ansiedad Beck (BAI) en una muestra de envejecidos puertorriqueños. Para esto se establecieron los siguientes objetivos: 1) evaluar la prevalencia de ansiedad en dicha muestra, 2) evaluar la consistencia interna del inventario y 3) realizar un análisis de estructura factorial del BAI. MATERIAL Y MÉTODO: El BAI y la planilla demográfica se administraron a una muestra de 150 personas entre las edades de 60 a 99 años. De éstos, 100 participantes residen en égidas del área metropolitana de Puerto Rico y 50 en la comunidad de la misma región. El concepto de égidas ha sido definido por la Oficina de Asuntos de la Vejez del Gobierno de Puerto Rico como lugar de residencia multi-pisos de ancianos funcionales. RESULTADOS: Los resultados indicaron: 1) que un 28,9 por ciento de la muestra mostró síntomas de ansiedad entre moderados y severos según medido por el BAI, 2) que el BAI mostró tener una alta consistencia interna según el coeficiente alfa de Cronbach (0,94) y 3) que la composición factorial del BAI se modifica a tres factores en una muestra de envejecidos puertorriqueños. CONCLUSIONES: Los resultados obtenidos sugieren que el BAI, en castellano, es un instrumento adecuado para medir ansiedad en ancianos puertorriqueños. Además, presentan la necesidad de investigar más a fondo la prevalencia y sintomatología de la ansiedad en dicha población (AU)

Decreased messenger RNA expression of key markers of the nigrostriatal dopaminergic system following vitamin E deficiency in the rat.

We have evaluated the effect of a vitamin E-deficient diet on the rat nigrostriatal dopaminergic system. After 15 days of deficient diet, the amount and activity of striatal and nigral tyrosine hydroxylase increased, which contrasted with a decreased messenger RNA expression for tyrosine hydroxylase and the dopamine transporter in the ventral mesencephalon. When we prolonged the deficiency of vitamin E for 30 days, dopamine levels did not differ in both areas. In contrast, messenger RNA levels for tyrosine hydroxylase and the dopamine transporter were markedly reduced in 30-day deficient rats. In addition, the number of oxidatively modified proteins significantly increased in the striatal and nigral areas studied. Overall, we propose that these changes suggest an important role of vitamin E in maintaining the normal equilibrium of the dopaminergic nigrostriatal system.

[Upward and downward gaze palsy with a unilateral mesencephalic hemorrhage]. / Parálisis combinada de la mirada vertical tras hemorragia unilateral del mesencéfalo.

INTRODUCTION: Acute vascular lesions limited to the midbrain can yield varied disturbances of eye movements. They are more often infarcts than hemorrhages. CLINICAL CASE: We present the case of a 49 year old, non-hypertensive man who presented with sudden onset of bilateral up and down gaze palsy. CT defined a unilateral hemorrhage in the right mesencephalic tegmentum. CONCLUSION: Cases of upward and downward gaze palsy in association with unilateral upper midbrain hemorrhage are very uncommon. We present a new case.

Parálisis combinada de la mirada vertical tras hemorragia unilateral del mesencéfalo / Upward and downward gaze palsy with a unilateral mesencephalic hemorrhage

Introducción. Las lesiones del mesencéfalo pueden dar lugar a trastornos diversos de la motilidad ocular entre los que destacan las supranucleares de la mirada vertical. Las causas vasculares son poco frecuentes y más a menudo se trata de infartos que de hemorragias. Caso clínico. Presentamos el caso de un varón de 49 años normotenso que presentó de modo brusco parálisis combinada de la mirada vertical superior e inferior. Una TC de cráneo demostró un hematoma localizado en el tegmento mesencefálico derecho. Conclusión. Presentamos un nuevo caso de parálisis combinada de la mirada vertical relacionado con un hematoma mesencefálico unilateral, una patología de presentación muy infrecuente (AU)

Normas éticas para el cuidado y utilización de los animales de experimentación / Ethical norms for the care and use of experimental animals

Introducción. La experimentación animal y la investigación con animales es una parte integral de la investigación clínica quirúrgica cuyo objetivo es resolver los problemas que se plantean en la clínica humana. Objetivo. La exposición de las normas éticas que deben regir la investigación con animales de experimentación. Métodos. Se describen los principios de un Código de Ética sobre el animal de laboratorio de ámbito internacional, las condiciones que deben cumplir el cuidado y utilización de los animales en investigación, recogidas en el Real Decreto 223/1988 de la Legislación Española y basadas en la Normativa de la Comunidad Europea 86/609. Se recogen los principios éticos y las responsabilidades del investigador en la experimentación animal, se exponen las condiciones de alojamiento en estabularios y su control, los cuidados que han de recibir los animales y el empleo de técnicas anestésicas. Conclusión. Los animales de laboratorio pueden y deben ser utilizados en beneficio de la ciencia y la salud pública ya que la experimentación animal ha contribuido al progreso de la ciencia quirúrgica al permitir la docencia, la investigación y el ensayo de nuevas técnicas e ideas. Su utilización siempre se regirá por principios éticos y se debe evitar su uso indiscriminado combinándolo con técnicas alternativa (AU)

[Sleep-arousal dissociation in a case of hypersomnia]. / Disociación vigilia-sueño en un caso de hipersomnia.

INTRODUCTION: Dissociated sleep-arousal states are clinical and experimental phenomena which represent mixed forms of the three stages of this cycle (arousal, NREM sleep and REM sleep). CLINICAL CASE: We describe the case of a man who presented with a history of excessive diurnal somnolence for the previous 5 years. He also had symptoms of sleep paralysis, hypnagogic hallucinations, automatic behavior and excessive movements during sleep. He had had no episodes of loss of muscle tone; MR was normal; HL DR2 and DQwl antigens were negative; two polisomnographic and a Multiple Latency Sleep test showed: 1. Absence of respiratory disorders. 2. Normal latency of REM sleep. 3. Periods of dissociated sleep (REM without atonia and arousal with atonia), and 4. An average sleep latency of 3.2 minutes and absence of REM periods. CONCLUSION: This case adds a new type of dissociated sleep state which may accompany the disorder known as hypersomnia without REM periods.

[Radial nerve lesions]. / Lesiones del nervio radial.

INTRODUCTION: The radial nerve is a prolongation of the posterior secondary trunk of the brachial plexous. It goes round the posterior aspect of the humerus, and is found anteriorly at the level of the forearm where it divides into two branches: 1. A deep motor branch, the posterior interosseus nerve; and 2. A superficial sensory branch, the superficial radial nerve. MATERIAL AND METHODS: Lesions of the radial nerve are studied by conduction tests (sensory and motor) and electromyography. Sensory manifestations of lesions of the radial nerve are usually limited to the dorso-lateral area of the hand. Motor disorders are usually seen as defects of extension, in which the triceps muscle may be involved depending on the level at which the lesion occurs. When topographical criteria are considered, the clinical syndromes of the radial nerve may be classified as: 1. Neuropathies of the main trunk; 2. Neuropathies of the posterior interosseus nerve; and 3. Neuropathies of the superficial radial nerve. Trauma, external compression and trapping are the main causes of lesions in these syndromes. CONCLUSIONS: The radial nerve may be involved in multi-neuropathic processes forming part of a systemic illness (vasculitis, diabetes, etc.) or of a purely neuro-muscular disorder (acute neuropathy of the brachial plexus, neuropathy due to the effect of pressure and motor multifocal neuropathy.

Apoyo social, actividad y salud en ancianos / Social support, activity, and health among the elderly

The present study examined the relationship between social support, activity level and physical health among a sample of 96 Puerto Rican elderly persons. The Spanish version of the Inventory of Socially Supportive Behaviors (ISSB28) was used to assess social support. Two structured questionnaires were administered to obtain measures of activity level and physical health. A multiple correlation-regression analysis was performed, and partial correlation coefficients were also obtained. A partial correlation of .48 (p < .001) was observed between the ISSB scores and the measure of physical health, indicating a direct relationship between poor health and social support. This finding is inconsistent with previous studies, which suggest that better health is associated with higher levels of social support. Moderate-low, negative correlations were found between activity level and 3 indicators of poor health. Thus, higher activity levels were associated with better physical health. For example, partial correlations of-.31 (p = .003) and -.29 (p = .007), respectively, were found between the activity level and the number and length of hospital stays. The correlation between the amount of surgical interventions undergone by the patient during the previous year and the activity level was -.28 (p = .009). These findings demonstrate that higher levels of activity are associated with better physical health in elderly persons, as indicated by less frequent and shorter hospital stays, and lower frequency of surgical interventions. Several multiple regression analyses showed that social support and activity level, taken together, are statistically significant predictors of the number and length of hospital stays, and the number of surgical interventions undergone by the elderly patient. Together, these two factors explain from 11 to 18% of the variability in several indicators of physical health

Estudio piloto sobre la ideación suicida en ancianos puertorriqueños en un Hospital de Salud Mental / Pilot study of suicidal ideation among elderly Puerto Ricans in a mental health hospital

This is one of the first descriptive-explorative studies done about suicidal thoughts in aging patients (age mean 60.7) within a mental health hospital in Puerto Rico. The purpose of this study was to identify common characteristics found in elderly patients that present suicidal thought and were hospitalized from January to June. The major finding indicates a great prevalence rate in men who were divorced, catholic, with a diagnosis on the axis I of the DSM IV and who had a previous history of such thoughts. In order to obtain a more comprehensive profile of the elderly patient with suicidal thoughts we suggest more research concerning this issue. Such investigations could be used in the prevention of elderly suicide

Increased activity and expression of tyrosine hydroxylase in the rat substantia nigra after chronic treatment with nomifensine.

We have studied the effect of chronic treatment with nomifensine on dopaminergic functioning in the nigrostriatal system. The striatal dopaminergic system was not altered by chronic nomifensine treatment. In contrast, there were overall decreases of different dopamine (DA) metabolites in the cell body region in the substantia nigra after nomifensine treatment, which clearly indicates a diminished DA turnover. These results suggest that long-lasting inhibition of the high affinity DA uptake system triggers long term regulatory, compensatory mechanisms in the cell body region to preserve normal dopaminergic function in the terminal field in striatum. We also tested whether transcriptional regulatory mechanisms were altered. We studied the cellular expression of tyrosine hydroxylase (TH) mRNA in substantia nigra by in situ hybridization, and the amount and activity of TH enzyme in the cell body and terminal field regions. Our results indicate that nomifensine treatment increased TH mRNA levels within individual nigral cells, which paralleled the changes in TH enzyme amount and activity in this brain area. Our data confirm the important role of the high affinity DA uptake system in regulating dopaminergic transmission in the nigrostriatal system.

[The clinical significance of auditory evoked potentials of the brainstem in neonates]. / Significado clínico de los potenciales evocados auditivos de troncoencéfalo en neonatos.

INTRODUCTION: Brainstem auditory evoked potentials (BAEP) are an objective test that provides an early detection of hearing losses and a functional evaluation of the auditory pathway. MATERIAL AND METHODS: All neonates born between November 1989 and December 1994 presenting some factor of audiologic or neurologic failure were tested by ABR, in order to determine the prognostic significance of abnormalities on follow-up. RESULTS: Of 40 selected babies 17 did not pass the former test and were classified as follows: eleven in a peripheral hearing loss group of mild-moderate degree and 6 in groups of severe peripheral hearing loss or central disorder of the auditory pathway. CONCLUSIONS: On follow-up an ABR test was included disclosing that many of the mild-moderate peripheral abnormalities has a transitory nature. Infants included in the other two groups had a very poor outcome from the point of view of life expectancy and psychomotor development.