Attention to acute cerebrovascular disease in Guipúzcoa: description of the results of a reference hospital in a centralized care model.

INTRODUCTION: In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS: We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION: We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS: After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.

Atención a la enfermedad cerebrovascular aguda en Guipúzcoa: descripción de los resultados de un hospital de referencia en un modelo de atención centralizado / Attention to acute cerebrovascular disease in Guipúzcoa: Description of the results of a reference hospital in a centralized care model

Introducción: En los últimos 15 años se han introducido importantes mejoras en la atención de la enfermedad cerebrovascular aguda (ECVA) en Guipúzcoa, que incluyen la implementación de un modelo centralizado en el Hospital Universitario Donostia (HUD), una mejor coordinación entre profesionales, campañas para su detección precoz, nuevos tratamientos, Unidad de Ictus y una rehabilitación específica. El objetivo de este trabajo es describir los resultados de un hospital de referencia (HUD) en un modelo de atención centralizado. Material y métodos: Estudio observacional retrospectivo de una muestra de pacientes dados de alta en el periodo de agosto-diciembre del año 2015 del HUD con diagnóstico de ECVA (CIE-9-MC-430-436 excepto 43310). Revisión de las características basales, atención en fase aguda y resultados funcionales y de mortalidad al alta y al año. Resultados y discusión: Se incluyó a 536 pacientes cuya media de edad fue de 73,6 años y cuya comorbilidad era elevada. El ictus isquémico supuso el 64,8% de las altas, seguido de la ECVA hemorrágica (20%) y del accidente isquémico transitorio (14,8%). Se atendió en < 6 h a un 53% de pacientes, activándose el «código ictus» en un 37,1%. Un 52,2% ingresó en la Unidad de Ictus. Un 11,34% de los pacientes con ictus isquémico recibió terapia por vía intravenosa y un 9,5% trombectomía mecánica. Un 12,1% de los pacientes con ECVA hemorrágica fue intervenido quirúrgicamente. El 56% inició rehabilitación en el hospital y un 39,6% la mantuvo al alta. La mortalidad al alta fue de un 13,8% y al año de un 25,9% (ictus isquémico: 25,3% y ECVA hemorrágica: 47,5%), menor a la descrita previamente en Guipúzcoa. Al año, un 62,5% de los pacientes tenían un ÿndice de Barthel 95-100 y un 50% una puntuación en escala de Rankin modificada 0-2. [...] (AU)

Introduction: In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. Material and methods: We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients’ baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. Results and discussion: We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. [...] (AU)

La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar / Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation

Objetivos: El objetivo fue explorar la experiencia de médicos y técnicos en cuidados auxiliares de enfermería (TCAE) respecto al manejo de contenciones mecánicas en unidades de cuidados críticos. Método: Estudio fenomenológico multicéntrico que incluyó 14 unidades de cuidados críticos (UCC) de Madrid (España). Las UCC fueron estratificadas en función del uso de contenciones mecánicas: «uso frecuente» versus «uso escaso». Se realizaron 3 grupos de discusión: el primero compuesto por TCAE procedentes de UCC con uso frecuente de contenciones mecánicas, el segundo grupo por TCAE de UCC de uso escaso de contenciones mecánicas y el último grupo por médicos de ambos subtipos de UCC. Método de muestreo: por propósito. Análisis de datos: análisis temático de contenido. Se alcanzó la saturación de los datos. Resultados: Emergen 4 temas principales: 1) concepto de seguridad y riesgo (seguridad del paciente versus seguridad del profesional); 2) tipos de contenciones; 3) responsabilidades profesionales (prescripción, registro y roles profesionales); y 4) paradigma «contención cero». La conceptualización sobre el uso de contenciones mecánicas muestra diferencias en algunos de los temas principales dependiendo del tipo de UCC en cuanto a políticas, uso y manejo de contenciones mecánicas (uso frecuente versus uso escaso). Conclusiones: La reducción real del uso de contenciones mecánicas en UCC debe partir de un punto clave: la aceptación de la complejidad del fenómeno. El uso de contenciones mecánicas observado en las diferentes UCC está influenciado por factores individuales, grupales y organizativos. Estos factores determinan las interpretaciones que médicos y TCAE realizan sobre seguridad y riesgo, el centro del cuidado (cuidado centrado en el paciente o en el profesional), el concepto de contención, las responsabilidades e intervenciones profesionales y las interacciones del equipo y el liderazgo

Objectives: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. Method; A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. Data analysis: thematic content analysis. Data saturation was achieved. Results: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). Conclusions; The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership

Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. / La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar.

OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.

Attention to acute cerebrovascular disease in Guipúzcoa: Description of the results of a reference hospital in a centralized care model. / Atención a la enfermedad cerebrovascular aguda en Guipúzcoa: descripción de los resultados de un hospital de referencia en un modelo de atención centralizado.

INTRODUCTION: In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model. MATERIAL AND METHODS: We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year. RESULTS AND DISCUSSION: We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in <6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2. CONCLUSIONS: After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.

Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera / Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality

Objetivos: Comprender la experiencia vivida por los enfermeros respecto a la gestión de la inmovilización terapéutica en Unidades de Cuidados Críticos. Explorar similitudes y diferencias en la experiencia enfermera respecto al manejo de la inmovilización terapéutica según el medio en el que están insertos. Método: Estudio fenomenológico multicéntrico en 14 Unidades de Cuidados Críticos de la Comunidad de Madrid estratificadas según el uso de inmovilización terapéutica: frecuente/sistemático, escaso/individualizado y mixto. Recogida de datos: 5 grupos de discusión (23 participantes). Muestreo intencional por propósito. Tamaño muestral: hasta saturación de datos. Análisis crítico temático del contenido guiado por el método de Colaizzi. Resultados: Emergen 6 grandes temas: 1) significado de inmovilización terapéutica en Unidades de Cuidados Críticos, 2) seguridad (autorretirada de dispositivos de soporte vital), 3) factores favorecedores, 4) sentimientos, 5) alternativas y 6) problemas pendientes. Aunque se significan los mismos temas en los 3 tipos de unidades, se observan diferencias en el discurso (indicación, sentimientos, herramientas validadas para la medición de dolor, sedación…). Conclusiones: Para conseguir una reducción real de la inmovilización terapéutica en Unidades de Cuidados Críticos, resulta clave la comprensión profunda de su uso en el medio específico. Al identificarse como eje central la autorretirada de dispositivos de soporte vital, algunas medidas propuestas en otros ámbitos podrían no resultar pertinentes, precisándose alternativas encaminadas a pacientes críticos. Las variaciones del discurso planteadas en los distintos tipos de unidades podrían arrojar luz sobre los puntos clave que determinan las diferencias de uso y actitudes hacia la inmovilización terapéutica

Aims: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. Method: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Findings: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. Conclusions: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint

[Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality]. / Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera.

AIMS: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. METHOD: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. FINDINGS: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. CONCLUSIONS: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint.

Levels of infection, pathology and nodule size of Onchocerca flexuosa (Nematoda: Onchocercidae) in red deer (Cervus elaphus) from northern Spain.

Between 2005 and 2007, the presence of Onchocerca flexuosa (Wedl, 1856) was discovered and investigated in 110 red deer (Cervus elaphus) shot in the Riaño Regional Hunting Reserve, in the province of León (north-western Spain). Nodules containing O. flexuosa were located in the dorsal region and flanks of the deer. These were collected and measured, and some adult parasites were extracted from the nodules and identified by morphology and by obtaining mitochondrial 12S rDNA sequences, which were identical to those of previously published sequences for O. flexuosa. Some nodules were prepared for histology, embedded in paraffin, sectioned and stained with haematoxylin-eosin. Histologically, the worms were found in several compartments separated by an infiltrated fibrous tissue. These compartments were inhabited by several females and males, surrounded by a fibrous capsule. A total of 85.45% (95% confidence interval (CI): 78.86-92.04%) of red deer were parasitized, with a mean intensity of 9.53 ± 12.27 nodules/host, ranging between 1 and 74 nodules/deer. Significant differences in prevalence and intensity of infection were found between young and adult red deer, and also between seasons. However, no significant differences between males and females were observed. Five hundred and ninety-seven nodules were measured (15.81 ± 3.94 mm) and classified by sizes into small ( < 10 mm), medium (10-20 mm) and large (>20 mm). No relation was found between the size of the nodules and the time of infection. The high values found in the studied parameters show that northern Spain is an area of high-intensity infection for deer.

La simulación mejora la confianza de los estudiantes para adquirir competencias en urología / Simulators Help Improve Student Confidence to Acquire Skills in Urology

Objetivos: Conocer el grado de confianza de los alumnos de quinto de Grado en Medicina para realizar las maniobras de sondaje vesical y tacto rectal, antes y después del entrenamiento con simuladores. En segundo lugar, valorar la satisfacción de los estudiantes respecto a la utilización de la simulación como metodología de aprendizaje. Material y métodos: El estudio se llevó a cabo en el Centro de Simulación de la Facultad de Medicina, y participaron los 173 estudiantes que realizaron el taller práctico de la asignatura de Urología. Mediante cuestionarios anónimos, los estudiantes respondieron a preguntas sobre su grado de confianza en la realización del sondaje vesical y el tacto rectal, antes y después del taller, y sobre la satisfacción general respecto a la simulación como herramienta de entrenamiento. Los talleres se organizaron en grupos de 10 alumnos y estaban dirigidos por un profesor o residente de dicha especialidad que supervisaba de manera individual, resolvía dudas e instruía en la técnica correcta. Resultados: Todas las valoraciones respecto a las distintas competencias fueron significativamente más altas tras el entrenamiento (p < 0,001). Se encontraron diferencias significativas en la confianza antes del entrenamiento entre varones y mujeres en la maniobras de sondaje uretral masculino y reconocimiento de próstata normal o patológica, siendo menor la confianza en mujeres (p < 0,05). Estas diferencias desaparecieron tras el entrenamiento. El grado de satisfacción general con el taller fue alto, de 4,47 ± 0,9 sobre una puntuación máxima de 5. Conclusiones: La simulación es un método de entrenamiento

Objective: To know the level of confidence of fifth-year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method. Materials and methods: The study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique. Results: All the evaluations made on the different abilities were significantly higher after training (p < 0.001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (p < 0.05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5. Conclusions: Simulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination

IP-10 is an accurate biomarker for the diagnosis of tuberculosis in children.

OBJECTIVE: Performance of IFN-γ assays in children is compromised. Therefore, we investigated the utility of IP-10 for the detection of active tuberculosis (TB) and latent tuberculosis infection (LTBI) diagnosis in children; comparing its positivity with QuantiFERON-TB Gold In-Tube (QFN-G-IT) and T-SPOT.TB. METHODS: We studied 230 children from three groups: active TB, screening (healthy children without known exposure to active TB patient screened at school or by their paediatrician) and contact-tracing studies. IFN-γ release was determined by QFN-G-IT and T-SPOT.TB. IP-10 was detected in QFN-G-IT supernatants by ELISA. RESULTS: When combining QFN-G-IT and IP-10 assays, positive results improved significantly from 38.3% in QFN-G-IT and 33.9% in IP-10 to 41.3%. Age and type of contact were significant risk factors associated with positive QFN-G-IT and IP-10 results. IP-10 levels after antigen-specific stimulation were significantly higher in comparison to IFN-γ levels. Correlation between the three assays was good (κ = 0.717-0.783). CONCLUSIONS: IP-10 cytokine is expressed in response to TB specific-antigens used in QFN-G-IT. In conclusion, the use of IFN-γ T-cell based assays in combination with an additional IP-10 assay detection could be useful for diagnosing active TB and LTBI in children.

Simulators help improve student confidence to acquire skills in urology.

OBJECTIVE: To know the level of confidence of fifth year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method. MATERIAL AND METHODS: The study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique. RESULTS: All the evaluations made on the different abilities were significantly higher after training (P<.001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (P<.05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5. CONCLUSIONS: Simulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination.

Papel de los polimorfismos de los genes CFH y ARMS2 en el desarrollo de la retinopatía y la cardiopatía isquémica en la diabetes tipo 1 / Role of CFH and ARMS2 polymorphisms in retinopathy and coronary artery disease in type 1 diabetes

Fundamento. La diabetes tipo 1 (DT1) es un enfermedad con elevada morbilidad vascular. El objetivo de este estudio es valorar la asociación de los polimorfismos rs1410996 del gen CFH y rs10490924 del gen ARMS2 en pacientes con DT1. Material y métodos. Se trata de un estudio retrospectivo, en el que se han analizado las características clínicas y los polimorfismos rs1410996 del gen CFH y rs10490924 del gen ARMS2 de 147 pacientes con DT1 valorados en la consulta de Endocrinología. Resultados. Todos los pacientes que desarrollaron retinopatía diabética proliferativa en los primeros 20 años de evolución eran portadores del polimorfismo rs1410996 del gen CFH. La frecuencia del alelo de riesgo fue significativamente mayor en los pacientes con cardiopatía isquémica que en los que no la presentaban (75 frente a 53%, p<0,001). Conclusiones. Parece existir una tendencia a aumentar el riesgo de desarrollar retinopatía diabética proliferativa en los pacientes con DT1 asociado con el polimorfismo rs1410996 del gen CFH. Este polimorfismo parece asociarse también con el desarrollo de cardiopatía isquémica en estos pacientes. Sin embargo, el polimorfismo rs10490924 del gen ARMS2 no parece asociarse con la retinopatía ni con la cardiopatía isquémica(AU)

Background. Type 1 diabetes is associated with vascular morbidity. The aim of this study was to evaluate the role of polymorphisms rs1410996 CFH and rs10490924 ARMS2 with proliferative diabetic retinopathy and coronary disease in type 1 diabetes patients. Material and methods. We present a retrospective study that analyses the clinical characteristics and the polymorphisms rs1410996 CFH and rs10490924 ARMS2 of 147 type 1 diabetes patients. Results. The patients who developed proliferative diabetic retinopathy in the first 20 years carried the rs1410996 CFH polymorphism. The overall risk-allele frequency was significantly higher among patients with coronary artery disease than in those without it (75 vs.53%, p<0.001). Conclusions. rs1410996 CFH polymorphism could be associated with both proliferative diabetic retinopathy and coronary artery disease in type 1 diabetes patients. However, rs10490924 ARMS2 does not seem to be associated either with retinopathy or coronary artery disease(AU)

Tratamiento combinado con radioterapia externa y hormonoterapia en los pacientes con cáncer de próstata localmente avanzado: factores predictivos de toxicidad genitourinaria / Combined External Radiotherapy and Hormone Therapy in Patients with Locally Advanced Prostate Cancer: Predictive Factors of Genitourinary Toxicity

Introducción: una opción de tratamiento del cáncer de próstata localmente avanzado es la radioterapia combinada con la ablación androgénica. Revisamos los resultados de eficacia y toxicidad del tratamiento combinado en un grupo de pacientes tratados con esta terapia combinada en nuestra institución. Material y método: estudio retrospectivo de 80 pacientes con cáncer prostático localmente avanzado tratados con radioterapia externa y hormonoterapia neoadyuvante (dos meses) y adyuvante (24 meses). Se realiza un estudio descriptivo de las variables clínico-patológicas y de los efectos secundarios. Evaluamos la respuesta al tratamiento mediante el PSA nadir y recidiva bioquímica. Analizamos la toxicidad aguda y crónica genitourinaria, intentando establecer qué factores influyen en su aparición mediante análisis uni y multivariante (regresión logística múltiple). Resultados: la media de edad fue 68 ± 5,81 años, el PSA inicial 20,05 ±1 6,27 ng/ ml y el volumen prostático medio 43,7 ± 27,57 cc. El 33% fueron estadio T3a y el 66% T3b. El Gleason fue < 7 en el 39%, 7 en el 46% y ≥ 8 en el 15%. Tras un seguimiento medio de 44,4 meses se detectó recidiva bioquímica en tres casos. La toxicidad aguda postirradiación genitourinaria apareció en el 90% (35% tardía) y gastrointestinal en el 75% (32% tardía). El análisis univariante muestra relación entre el volumen prostático y los síntomas urinarios previos con la toxicidad genitourinaria aguda y crónica. Estos se confirman como factores predictivos independientes de toxicidad geniturinaria en el análisis de regresión logística. Conclusiones: la hormono-radioterapia es una opción válida para el tratamiento del cáncer localmente avanzado con resultados óptimos a corto plazo, aunque no está exenta de efectos secundarios. La sintomatología urinaria previa y el volumen prostático pueden predecir la toxicidad genitourinaria (AU)

Introduction: Radiotherapy and androgen deprivation are an established treatment option for locally advanced prostate cancer. We evaluate outcomes in efficacy and toxicity for patients treated with this combined therapy at our institution. Methods: A retrospective study of 80 patients with locally advanced prostate cancer treated with radiotherapy combined with neo-adjuvant (2 months) and adjuvant (24 months) androgen deprivation. We studied the clinical variables and side effects. We evaluated treatment outcomes using PSA nadir and biochemical failure, and recorded acute and late gastrointestinal and urinary toxicity. We assessed the correlation between clinical variables and urinary toxicity by means of univariate and multivariate analyses (multiple logistic regression). Results: The mean patient age was 68 ± 5.81 years; the initial PSA was 20.05 ± 16.27 ng/ ml and the mean prostate volume 43.7 ± 27.57 cc. The clinical stage was T3a in 33% and T3b in 66%. The Gleason score was <7 in 39%, 7 in 46% and ≥8 in 15%. The mean follow-up was 44.4 months and biochemical failure was observed in 3 cases. Acute urinary toxicity was recorded in 90% of the patients (chronic in 35%) and acute gastrointestinal toxicity in 75% (late in 32%). In a univariate analysis, prostate volume and urinary symptoms were statistically correlated to acute and late urinary toxicity. Both prostate volume and urinary symptoms were independently associated with an increase in urinary toxicity in the logistic regression analysis. Conclusions: Hormone-radiotherapy is a valid option to locally treat advanced prostate cancer with optimal short-term outcomes, although it is not devoid of side effects. Prostate volume and urinary symptoms before treatment can predict genitourinary toxicity (AU)

[Combined external radiotherapy and hormone therapy in patients with locally advanced prostate cancer: predictive factors of genitourinary toxicity]. / Tratamiento combinado con radioterapia externa y hormonoterapia en los pacientes con cáncer de próstata localmente avanzado: factores predictivos de toxicidad genitourinaria.

INTRODUCTION: Radiotherapy and androgen deprivation are an established treatment option for locally advanced prostate cancer. We evaluate outcomes in efficacy and toxicity for patients treated with this combined therapy at our institution. METHODS: A retrospective study of 80 patients with locally advanced prostate cancer treated with radiotherapy combined with neo-adjuvant (2 months) and adjuvant (24 months) androgen deprivation. We studied the clinical variables and side effects. We evaluated treatment outcomes using PSA nadir and biochemical failure, and recorded acute and late gastrointestinal and urinary toxicity. We assessed the correlation between clinical variables and urinary toxicity by means of univariate and multivariate analyses (multiple logistic regression). RESULTS: The mean patient age was 68 ± 5.81 years; the initial PSA was 20.05 ± 16.27 ng/ ml and the mean prostate volume 43.7 ± 27.57 cc. The clinical stage was T3a in 33% and T3b in 66%. The Gleason score was <7 in 39%, 7 in 46% and ≥8 in 15%. The mean follow-up was 44.4 months and biochemical failure was observed in 3 cases. Acute urinary toxicity was recorded in 90% of the patients (chronic in 35%) and acute gastrointestinal toxicity in 75% (late in 32%). In a univariate analysis, prostate volume and urinary symptoms were statistically correlated to acute and late urinary toxicity. Both prostate volume and urinary symptoms were independently associated with an increase in urinary toxicity in the logistic regression analysis. CONCLUSIONS: Hormone-radiotherapy is a valid option to locally treat advanced prostate cancer with optimal short-term outcomes, although it is not devoid of side effects. Prostate volume and urinary symptoms before treatment can predict genitourinary toxicity.

Intervención logopédica en un caso de síndrome de Cornelia de Lange / Speech and language intervention in a Cornelia de Lange syndrome case

Se presenta a continuación la intervención logopédica realizada durante 2 años en un caso de síndrome de Cornelia de Lange (SCdL). El SCdL es una enfermedad rara, caracterizada por retraso pre y posnatal del crecimiento; presenta rasgos faciales característicos, malformaciones musculo esqueléticas en manos, pies, brazos y piernas y otras malformaciones físicas. Los niños afectados pueden presentar también retraso psicomotor (retrasos en la adquisición de las habilidades de la coordinación y de la actividad mental y muscular) y retraso mental de leve a severo. El rango y la severidad de los síntomas pueden variar de unos casos a otros. La mayor parte de la bibliografía acerca del síndrome hace referencia a las características físicas y a los síntomas, pero rara vez encontramos información que pueda orientar a los que nos dedicamos a la intervención para aplicar un programa de tratamiento. Esta escasez bibliográfica es lo que nos ha llevado a plantear el interés que podría suponer el hecho de presentar la intervención en un caso de estas características. A continuación se expone la descripción clínica del caso, la evaluación realizada y la intervención en las áreas de terapia miofuncional, comunicación y lenguaje. Se finaliza con la exposición de los resultados obtenidos en estas áreas de intervención y las conclusiones (AU)

The following case study reveals a speech therapy intervention carried out for two years in a particular case of Cornelia de Lange Syndrome (CdLS). CdLS is a rare genetic disorder characterised by a delay in pre and postnatal child development. It shows distinctive facial features and muscular anomalies – bones mutations in hands, feet, arms, legs and other physical abnormalities. The children affected may also display delayed psychomotor development (delay in the acquisition of abilities related to coordination, intellectual and muscular development) and -low to severe-mental impairment. The range and severity of symptoms may vary depending on each case. Most of the existing bibliography makes reference to the physical characteristics and symptoms, being barely information that supports the intervention of professionals applying treatment programs. This particular academic context has leaded us to focus our interest in exposing the intervention in a case of such characteristics. This is an extended case study about the clinic description of the case, evaluation and types of intervention in areas of my functional therapy, communication and language. We will finalize by exposing the results obtained in these areas of intervention, and bringing our own conclusion (AU)

Second-order data obtained by time-resolved room temperature phosphorescence. A new approach for PARAFAC multicomponent analysis.

A second-order multivariate calibration approach, based on a combination of PARAFAC with time-resolved room temperature phosphorescence (RTP), has been applied to resolve a binary mixture of Phenanthrene and 1,10-Phenanthroline, as model compounds. The RTP signals were obtained in aqueous beta-cyclodextrin solutions, in the presence of several heavy atom containing compounds. No deoxygenation was necessary to obtain the phosphorescence signals, which adds simplicity to the method. The resolution of the model compounds was possible in base to the differences in the delay-time of the RTP signals of the investigated analytes, opening a new approach for second-order data generation and subsequent second order multivariate calibration.

Binding of factor VIIa to the endothelial cell protein C receptor reduces its coagulant activity.

BACKGROUND: Endothelial cell protein C receptor (EPCR) binds protein C through its gamma-carboxyglutamic acid (Gla) domain and enhances its thrombin-thrombomodulin complex-dependent activation. So far, only protein C/activated protein C has been shown to interact with EPCR. Factor VII (FVII), the coagulation trigger upon tissue factor (TF) interaction, is a serine protease whose Gla domain is highly homologous to the Gla domain of protein C. OBJECTIVES: To characterize the binding of FVII/FVIIa to EPCR and its functional consequences. METHODS AND RESULTS: We demonstrated by surface plasmon resonance (SPR) that FVII/FVIIa binds to EPCR through its Gla domain. At therapeutic concentrations, FVIIa reduced the activation of protein C by 40%. Soluble EPCR (sEPCR) was also able to prolong dose-dependently the clotting time induced by the FVIIa-TF complex. SPR and amidolytic experiments showed that FVIIa is able to interact simultaneously with TF and EPCR, thus ruling out the possibility that the effect of EPCR on clotting time was due to the inhibition of the binding between FVIIa and TF. sEPCR inhibited dose-dependently the activation of FX by the FVIIa-TF complex. Notably, blocking the binding site of EPCR on the endothelial surface increased the generation of FXa 2-fold. CONCLUSIONS: EPCR binds to FVII/FVIIa and inhibits the procoagulant activity of the FVIIa-TF complex.

Fluorimetric determination of sulphaguanidine and sulphamethoxazole by host-guest complexation in beta-cyclodextrin and partial least squares calibration.

The host-guest inclusion complexes of sulphamethoxazole (SMTX) and sulphaguanidine (SGN) with beta-cyclodextrin, in aqueous solutions, have been investigated. A 1:1 stoichiometry of the complexes was established, the association constants were calculated by different methods, and the influence of several chemical variables on the complexation processes were established. According to the results obtained, a spectrofluorimetric method for the determination of these sulphonamides has been proposed. The individual and binary mixtures of both sulphonamides have been determined in human urine samples, at representative therapeutic ranges, by application of a first-order multivariate calibration partial least squares (PLS-1) model. The calibration set was designed with 9 samples, containing different concentrations of the two sulphonamides, and 8 blank urine samples, with the aim of modelling the variability of the background. The concentration ranges for the sulphonamides were up to 0.5 microg mL(-1) for SMTX and 1.0 microg mL(-1) for SGN. Figures of merit as selectivity, analytical sensitivity and limit of detection (LOD) were also calculated. The proposed procedure was validated by comparing the obtained results with a HPLC method, with satisfactory results for the assayed method.

A chemometric sensor for determining sulphaguanidine residues in honey samples.

The inclusion complex of sulphaguanidine (SGN) in beta-cyclodextrin has been investigated. To avoid the problem of the low solubility of beta-cyclodextrin in water, solutions of beta-cyclodextrin in urea have been used. A 1:1 stoichiometry and an association constant of 450M(-1) have been established for the complex. A new spectrofluorimetric method has been developed for the determination of SGN residues in honey samples. This sulphonamide is widely employed for honey treatment. The method for the determination is based on second-order multivariate calibration, applying parallel factor analysis (PARAFAC). No previous separation or samples pre-treatment were required. The calibration solutions were prepared in water, with concentrations in the range from 0.02 to 0.20mugmL(-1) for SGN. The use of the second-order calibration method in the standard addition mode, using the excitation-emission matrices (EEMs) as analytical signal, allowed its determination in honey samples, even in the presence of interferences, with satisfactory results. The proposed procedure was validated by comparing the obtained results with a HPLC method, with satisfactory results for the assayed method.

Release of ferulic acid and feruloylated oligosaccharides from sugar beet pulp by Streptomyces tendae.

Given several promising industrial applications of ferulic acid, this study was designed to identify actinomycete strains able to release high levels of this acid from sugar beet pulp (SBP). Out of 47 strains tested, 37% were found to release free ferulic acid from the growth substrate. One strain, identified as Streptomyces tendae by 16S RNA gene sequencing, was capable of releasing 80% of the ferulic acid ester-linked to the pectin in SBP after 5 days of growth. These data suggest that some actinomycetes are able to release ferulic acid and feruloylated oligosaccharides from SBP. During growth on SBP, it seems that Streptomyces species solubilize and release feruloylated oligosaccharides by specific carbohydrase activities before de-esterification and release of free ferulic acid.