Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study.

BACKGROUND: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.

Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19 / Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic

Introducción: El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos: Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados: Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones: La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.(AU)

Introduction: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. Patients and methods: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. Results: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. Conclusions: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.(AU)

[Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic]. / Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.

Biomaterials for bone regeneration: an orthopedic and dentistry overview.

Because bone-associated diseases are increasing, a variety of tissue engineering approaches with bone regeneration purposes have been proposed over the last years. Bone tissue provides a number of important physiological and structural functions in the human body, being essential for hematopoietic maintenance and for providing support and protection of vital organs. Therefore, efforts to develop the ideal scaffold which is able to guide the bone regeneration processes is a relevant target for tissue engineering researchers. Several techniques have been used for scaffolding approaches, such as diverse types of biomaterials. On the other hand, metallic biomaterials are widely used as support devices in dentistry and orthopedics, constituting an important complement for the scaffolds. Hence, the aim of this review is to provide an overview of the degradable biomaterials and metal biomaterials proposed for bone regeneration in the orthopedic and dentistry fields in the last years.

A Qualitative View of Migration-Related Stressors on the Mental Health of Latinx Americans in the Current Sociopolitical Climate of Hostility Towards Migrants.

This qualitative study aimed to elucidate and contextualize which and how migration-related stressors may influence Latinx Americans' (i.e., US-born; US-citizens) mental health status, including substance misuse. In 2019, a community sample of 22 Latinx Americans were recruited for an in-depth qualitative interview. Eligibility criteria included: being an adult, self-identify as Latinx, report a migration-related stressor, and report at least one symptom of a mental health or substance use problem. Open-ended questions focused on the migrant experience, perceptions and impacts of immigration enforcement, and how these experiences related to their mental health. Using a migration as a social determinant framework, we identified several migration-related stressors at the structural- and social-level of environmental influence that were related to participants' mental health. Findings highlight how migration-related stressors at the structural- and social-level of influence create systematic uncertainty by inducing fear into the daily lives of Latinx Americans.

Biomaterials for bone regeneration: an orthopedic and dentistry overview

Because bone-associated diseases are increasing, a variety of tissue engineering approaches with bone regeneration purposes have been proposed over the last years. Bone tissue provides a number of important physiological and structural functions in the human body, being essential for hematopoietic maintenance and for providing support and protection of vital organs. Therefore, efforts to develop the ideal scaffold which is able to guide the bone regeneration processes is a relevant target for tissue engineering researchers. Several techniques have been used for scaffolding approaches, such as diverse types of biomaterials. On the other hand, metallic biomaterials are widely used as support devices in dentistry and orthopedics, constituting an important complement for the scaffolds. Hence, the aim of this review is to provide an overview of the degradable biomaterials and metal biomaterials proposed for bone regeneration in the orthopedic and dentistry fields in the last years.

Women's Barriers to Specialty Substance Abuse Treatment: A Qualitative Exploration of Racial/Ethnic Differences.

To explore barriers to specialty substance abuse treatment programs among women with recent substance use disorders by race/ethnicity. Qualitative interviews were conducted with 28 women of White, Black, and Latino racial/ethnic descent who reported a substance use disorder in the past 5 years. Interviews were conducted by telephone and were audio-recorded. A codebook was developed using the Theory of Planned Behavior to code and identify barriers within the domains of attitudes, subjective norms, and perceived control toward specialty treatment. Frequencies for coded themes were then compared across all participants and by race/ethnicity. We identified several key differences in barriers to treatment by race/ethnicity. Attitudinal barriers were more pervasive among the narratives of Latinas relative to Black and White women. Latinas were more likely to report not needing treatment and that treatment would not be effective; Latinas were the only group to describe cultural barriers to treatment. Within the subjective norms domain, namely stigma and lack of support, were key barriers. Stigma was more pervasive among the narratives of Latinas and Black women than White women; Latinas were more likely to report a lack of social support for using treatment than both Black and White women. Findings provide deeper insight into barriers that may be contributing to racial/ethnic disparities in the use of substance abuse treatment among women.

Radiofrequency ablation for non-small-cell lung cancer in a single-lung patient: case report and review of the literature.

BACKGROUND: Radiofrequency thermal ablation is an alternative option to manage primary or metastatic lung malignancies. It is particular useful for unresectable lesions because of the disease's location, prior resection, or comorbidities. Patients presenting with a lung tumor that occurs in a single lung due to a prior pneumonectomy are difficult to manage with a curative intent due to the risk of complications after local treatment. MATERIALS AND METHODS: We hereby report on treatment of a primary non-small-cell lung cancer in a previously contralateral pneumonectomised patient using per-cutaneous pulmonary radiofrequency thermal ablation. We also discuss literature that describes similar alternative minimally invasive procedures. CONCLUSION: Despite being a high-risk procedure, radiofrequency should be considered for patients with a single lung particularly when ineligible to surgery or stereotactic ablative radiation therapy. The procedure should be ideally associated with a pre-operative preventive chest tube.

Quality of life and economic impact of refractory epilepsy in Spain: the ESPERA study.

INTRODUCTION: Despite use of currently available anti-epileptic drugs (AED), 30% of epilepsy patients are not seizure-free. The purpose of this study was to estimate the quality of life and economic impact in Spain of drug-resistant epilepsy (DRE), as defined by the International League Against Epilepsy (ILAE). METHODS: Observational retrospective 12-month study conducted in Spain including adults with focal epilepsy treated with at least two AEDs. Direct costs (€ 2010) were calculated based on health care resources used and their official unit costs. Costs were analysed from the perspectives of the Spanish National Health System (SNS) and society. The impact of DRE on patients' quality of life was examined using the QOLIE 31-P, EQ-5D-3L, and NDDIE questionnaires. RESULTS: We analysed 263 patients out of the 304 recruited. According to ILAE criteria, 70.0% of the patients had drug-resistant epilepsy, while 20.3% achieved seizure freedom. From the viewpoint of the SNS, annual costs for resistant and seizure-free patients were € 4964 and € 2978 respectively (P<.01). Compared to resistant patients, seizure-free patients showed better scores on QOLIE-31P (70.8 vs 56.4, P<.0001) and EQ-5D-3L (75.6 vs 64.7, P<.001). Seizure-free patients showed a lower incidence of major depression compared to resistant patients according to the NDDIE scale (23 vs 8.3%, P<.05). CONCLUSIONS: Results suggest that DRE is associated with increased use of healthcare resources and consequently with higher costs, poorer quality of life and higher incidence of major depression compared to seizure-free patients, thus representing a considerable burden to the SNS and society.

Prediction of early stroke recurrence in transient ischemic attack patients from the PROMAPA study: a comparison of prognostic risk scores.

BACKGROUND: Several clinical scales have been developed for predicting stroke recurrence. These clinical scores could be extremely useful to guide triage decisions. Our goal was to compare the very early predictive accuracy of the most relevant clinical scores [age, blood pressure, clinical features and duration of symptoms (ABCD) score, ABCD and diabetes (ABCD2) score, ABCD and brain infarction on imaging score, ABCD2 and brain infarction on imaging score, ABCD and prior TIA within 1 week of the index event (ABCD3) score, California Risk Score, Essen Stroke Risk Score and Stroke Prognosis Instrument II] in consecutive transient ischemic attack (TIA) patients. METHODS: Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). A neurologist treated all patients within the first 48 h after symptom onset. The duration and typology of clinical symptoms, vascular risk factors and etiological work-ups were prospectively recorded in a case report form in order to calculate established prognostic scores. We determined the early short-term risk of stroke (at 7 and 90 days). To evaluate the performance of each model, we calculated the area under the receiver operating characteristic curve. Cox proportional hazards multivariate analyses determining independent predictors of stroke recurrence using the different components of all clinical scores were calculated. RESULTS: We calculated clinical scales for 1,137 patients (90.6%). Seven-day and 90-day stroke risks were 2.6 and 3.8%, respectively. Large-artery atherosclerosis (LAA) was observed in 190 patients (16.7%). We could confirm the predictive value of the ABCD3 score for stroke recurrence at the 7-day follow-up [0.66, 95% confidence interval (CI) 0.54-0.77] and 90-day follow-up (0.61, 95% CI 0.52-0.70), which improved when we added vascular imaging information and derived ABCD3V scores by assigning 2 points for at least 50% symptomatic stenosis on carotid or intracranial imaging (0.69, 95% CI 0.57-0.81, and 0.63, 95% CI 0.51-0.69, respectively). When we evaluated each component of all clinical scores using Cox regression analyses, we observed that prior TIA and LAA were independent predictors of stroke recurrence at the 7-day follow-up [hazard ratio (HR) 3.97, 95% CI 1.91-8.26, p < 0.001, and HR 3.11, 95% CI 1.47-6.58, p = 0.003, respectively] and 90-day follow-up (HR 2.35, 95% CI 1.28-4.31, p = 0.006, and HR 2.20, 95% CI 1.15-4.21, p = 0.018, respectively). CONCLUSION: All published scores that do not take into account vascular imaging or prior TIA when identifying stroke risk after TIA failed to predict risk when applied by neurologists. Clinical scores were not able to replace extensive emergent diagnostic evaluations such as vascular imaging, and they should take into account unstable patients with recent prior transient episodes.

Anestesia subaracnoidea selectiva: Soluciones diluidas a bajas dosis / No disponible

No disponible

[Treatment of distal humeral shaft fractures at Polanco Mexican Red Cross]. / Tratamiento de las fracturas diafisarias del tercio distal de húmero en la Cruz Roja Mexicana Polanco.

OBJECTIVE: To determine which is the most effective treatment for the management of soft tissues, the functional recovery and the healing of distal third humeral shaft fractures at the Mexican Red Cross trauma center. MATERIAL AND METHODS: This is a retrospective, longitudinal, comparative study of patients with a diagnosis of distal third humeral shaft fractures; clinical and radiographic follow-up was done with the MEPI, UCLA and Montoya functional scales at week 24. RESULTS: The results of patient follow-up using the MEPI in Group I were: 2 poor, 3 fair, 1 excellent; in Group II: 8 excellent; in Group III: 3 poor, 2 fair, 4 excellent; in Group IV: 1 poor, 5 fair and 2 excellent. The UCLA results were: Group I, 3 poor, 2 good, 2 excellent; Group II: 5 excellent, 2 good; Group III, 4 poor, 1 partial, 2 good and 2 excellent; Group IV, 4 partial, 2 good, 2 excellent. The results of the Montoya scale were: Group I, 3 stage II, 1 stage III, 2 stage IV; Group II, 3 stage III, 5 stage IV; Group III, 3 stage II, 5 stage III, 1 stage IV; Group IV, 2 stage II, 2 stage III, 4 stage IV. DISCUSSION: This paper shows that the anterior 4.5 mm LCP MI plate has been the best treatment for distal third humeral shaft fractures.

[Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl]. / Anestesia subaracnoidea hipobárica a dosis bajas para cirugía anorrectal en posición de navaja: comparación entre levobupivacaína-fentanilo y lidocaína-fentanilo.

OBJECTIVE: To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS: Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 microg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 microg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS: Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS: Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position.

Anestesia subaracnoidea hipobárica a dosis bajas para cirugía anorrectal en posición de navaja: comparación entre levobupivacaína-fentanilo y lidocaína-fentanilo / Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl

INTRODUCCIÓN: El objetivo de este estudio fue comparar el porcentaje de pacientes que evitaban su paso (bypass) por la unidad de recuperación postanestésica (URPA) después de una anestesia subaracnoidea selectiva con lidocaína- fentanilo respecto a otra de levobupivacaína-fentanilo, en cirugía anorrectal realizada en pacientes en posición de navaja. MATERIAL YMÉTODOS: Estudio aleatorizado, prospectivo y doble ciego. Se compararon dos grupos de 30 pacientes, ASA I-II. El grupo Lido recibió 18 mg de lidocaína 0,6% más 10 μg fentanilo y el grupo Levo 3 mg de levobupivacaína 0,1% más 10 μg fentanilo. Se monitorizaron las siguientes variables intraoperatorias: tiempo de inicio de la cirugía, nivel máximo de bloqueo sensitivo, necesidad de suplementación analgésica, aparición de eventos hemodinámicos. El nivel sensitivo se registró a los 5, 10 y 15 minutos y al final de la cirugía. Tras la cirugía se registró el grado de bloqueo motor, el nivel de propiocepción, el test de Romberg y si el paciente podía puentear la Unidad de recuperación postanestésica. Los tiempos de deambulación y de alta a domicilio, las complicaciones y la satisfacción postoperatoria también fueron registradas. RESULTADOS: No se observó diferencias significativas entre los grupos en cuanto a variables intraoperatorias. El 100% de los pacientes del estudio fue directamente a la unidad de adaptación al medio sin pasar por la URPA. Los tiempos para la deambulación, el alta a domicilio, así como las complicaciones y la satisfacción global postoperatoria fueron similares en ambos grupos. CONCLUSIONES: Ambas soluciones intratecales producen anestesia selectiva efectiva proporcionando un porcentaje de bypass de la URPA similar en cirugía anorrectal en posición de navaja(AU)

OBJECTIVE: To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS: Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 μg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 μg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS: Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS: Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position(AU)

Anestesia subaracnoidea hipobárica a dosis bajas para cirugía anorrectal en posición de navaja: comparación entre levobupivacaína-fentanilo y lidocaína-fentanilo / Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl

INTRODUCCIÓN: El objetivo de este estudio fue comparar el porcentaje de pacientes que evitaban su paso (bypass) por la unidad de recuperación postanestésica (URPA) después de una anestesia subaracnoidea selectiva con lidocaína- fentanilo respecto a otra de levobupivacaína-fentanilo, en cirugía anorrectal realizada en pacientes en posición de navaja. MATERIAL YMÉTODOS: Estudio aleatorizado, prospectivo y doble ciego. Se compararon dos grupos de 30 pacientes, ASA I-II. El grupo Lido recibió 18 mg de lidocaína 0,6% más 10 μg fentanilo y el grupo Levo 3 mg de levobupivacaína 0,1% más 10 μg fentanilo. Se monitorizaron las siguientes variables intraoperatorias: tiempo de inicio de la cirugía, nivel máximo de bloqueo sensitivo, necesidad de suplementación analgésica, aparición de eventos hemodinámicos. El nivel sensitivo se registró a los 5, 10 y 15 minutos y al final de la cirugía. Tras la cirugía se registró el grado de bloqueo motor, el nivel de propiocepción, el test de Romberg y si el paciente podía puentear la Unidad de recuperación postanestésica. Los tiempos de deambulación y de alta a domicilio, las complicaciones y la satisfacción postoperatoria también fueron registradas. RESULTADOS: No se observó diferencias significativas entre los grupos en cuanto a variables intraoperatorias. El 100% de los pacientes del estudio fue directamente a la unidad de adaptación al medio sin pasar por la URPA. Los tiempos para la deambulación, el alta a domicilio, así como las complicaciones y la satisfacción global postoperatoria fueron similares en ambos grupos. CONCLUSIONES: Ambas soluciones intratecales producen anestesia selectiva efectiva proporcionando un porcentaje de bypass de la URPA similar en cirugía anorrectal en posición de navaja(AU)

OBJECTIVE: To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS: Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 μg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 μg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS: Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS: Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position(AU)

Implementation effects of GFATM-supported HIV/AIDS projects on the health sector, civil society and affected communities in Peru 2004-2007.

The emergence of opportunities for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for HIV-related projects has so far generated funding of over US$75 million for three proposals in Peru. The size of this investment creates the need for close monitoring to ensure a reasonable impact. This paper describes the effects of collaboration with the GFATM on key actors involved in HIV-related activities and on decision-making processes; on health sector divisions; on policies and sources of financing; on equity of access; and on stigma and discrimination of vulnerable and affected populations. Data analysed included primary data collected through interviews with key informants, in-depth interviews and group discussions with vulnerable and affected populations, as well as several public documents. Multisectorality, encouraged by the GFATM, is incipient; centralist proposals with limited consultation, a lack of consensus and short preparation times prevail. No accountability mechanisms operate at the Country Coordinating Mechanism (CCM) level regarding CCM members or society as a whole. GFATM-funded activities have required significant input from the public sector, sometimes beyond the capacity of its human resources. A significant increase in HIV funding, in absolute amounts and in fractions of the total budget, has been observed from several sources including the National Treasury, and it is unclear whether this has implied reductions in the budget for other priorities. Patterns of social exclusion of people living with HIV/AIDS are diverse: children and women are more valued; while transgender persons and sex workers are often excluded.

The role of cyclooxygenase (COX)-2 derived prostanoids on vasoconstrictor responses to phenylephrine is increased by exposure to low mercury concentration.

We have previously demonstrated that chronic exposure to low-dose of mercury induced endothelial dysfunction and increased vasoconstrictor responses. The aim of this work was to investigate if mercury exposure alters contractile prostanoids production from cyclooxygenase-2 (COX-2) and its contribution to phenylephrine responses. For this, aortic segments from 3-month old Wistar rats daily treated with HgCl(2) (1(st) dose 4.6 microg/kg, subsequent dose 0.07 microg/kg/day, i.m.) or vehicle for 30 days were used. Mercury treatment did not affect systolic blood pressure but increased phenylephrine-induced vasoconstriction. The non selective COX inhibitor, indomethacin (10 micromol/l) reduced the response to phenylephrine more in aortic segments from mercury-treated than control rats. The selective COX-2 inhibitor NS 398 (1 micromol/l), the thromboxane A(2)/prostaglandin H(2) receptor (TP) antagonist SQ 29,548 (1 micromol/l), the TXA(2) synthase inhibitor furegrelate (1 micromol/l), the EP(1) receptor antagonist SC 19220 (1 micromol/l) and the AT(1) receptor antagonist losartan (10 micromol/l) reduced phenylephrine response only in vessels from mercury-treated rats. TXA(2) and PGE(2) levels were greater in the incubation medium of vessels from treated than untreated rats; NS 398 decreased these levels only in the mercury group. COX-2 protein was localized in adventitial and endothelial cells. Aortic COX-2 mRNA expression and plasma angiotensin converting enzyme activity were greater in mercury-treated rats. These results suggest that treatment with low doses of mercury increases the release of COX-2-derived vasoconstrictor prostanoids and its participation in phenylephrine responses. The increased activation of the renin-angiotensin system after mercury treatment might be associated to this increased COX-2 activity.

[Time to first antibiotic dose in community-acquired pneumonia diagnosed in an emergency department]. / Tiempo hasta la administración de la primera dosis de antibiótico en las neumonías adquiridas en la comunidad en un Servicio de Urgencias Hospitalario.

BACKGROUND: Early antibiotic administration to patients diagnosed of community-acquired pneumonia (CAP) has been associated with a lower mortality. In the USA, its administration within four hours has been implanted as a quality standard. The objective of this work was to analyze, in a Spanish emergency department, the performance with patients with CAP, focusing on the administration of the first dose of antibiotic. PATIENTS AND METHOD: Clinics, welfare and organizational aspects have been analysed on 93 patients diagnosed of CAP in an emergency department in order to identify their influence on antibiotic administration within 4 hours. RESULTS: 46.2% of patients received antibiotics within 4 hours. The fact that patients were assisted in the higher complexity level showed a positive association with the antibiotic administration within 4 hours. On the contrary, presence of more than 10 patients waiting to be admitted showed a negative association. CONCLUSIONS: Early antibiotic administration in the CAP is possible. On order to guarantee a higher number of patients taking antibiotics within 4 hours we have to improve quality of care in both the emergency department (to guarantee correct classification according to the level of complexity) and in the hospital (management of beds to avoid delay in the admission of the patients).