[Study of sociodemographic and psychopathological risk factors in suicide attempts. 2008-2010]. / Análisis de los intentos de autolisis en un área de salud. 2008-2010.

OBJECTIVE: The aim of this study is to determine the sociodemographic and psychopathological features and risk factors associated with suicide attempts. DESIGN: A descriptive cross-sectional study based on medical records. Emergency Primary Care Centres (Jumilla, Yecla) and Hospital Emergency Departments (Yecla, Murcia, Spain). RESULTS: The suicide attempt rate increases in younger people (average of 36.4 years old). Suicide attempts are higher among women (67%). In terms of psychopathological data, suicide attempts were characterised by a higher prevalence of depression and anxiety disorder (30%), and substance abuse (13%). The percentage of patients who had made a previous suicide attempt was 37%. Self-poisoning was the most recurrent method of suicide attempt, present in at least 80% of the cases. Gender was a significant factor in the cause of suicide attempt (P=.042) and psychopathology (P=.011). The geographic origin of the patient is significantly associated with the suicide method used (P=.000). CONCLUSIONS: Suicide treatment protocols and suicide prevention programs must be developed, as well as recording the risk factors in the patient history.

Análisis de los intentos de autolisis en un área de salud. 2008-2010 / Study of sociodemographic and psychopathological risk factors in suicide attempts. 2008-2010

Objetivo. Se trata de estudiar el porcentaje de pacientes con intentos de autolisis valorados en un área de salud sin psiquiatra de guardia y analizar las características de los mismos. Material y métodos. Estudio descriptivo, transversal. Se han estudiado el total de las consultas atendidas por intento de autolisis durante los años 2008, 2009 y 2010, en el área V-Región de Murcia. Los criterios de exclusión han sido los intentos de autolisis con consecuencia de fallecimiento. Resultados. La edad media de los pacientes que consultaron por intento de autolisis fue 36,4 años. El 67% de los pacientes fueron mujeres. Los antecedentes psiquiátricos más prevalentes fueron, síndrome ansioso-depresivo (30%), abuso de drogas (13%) y patología dual (10%). El 37% de los pacientes que realizó un intento de autolisis tenía antecedentes de intentos previos. El 80% de los intentos de autolisis fue por consumo de fármacos o la combinación de fármacos, alcohol y drogas ilegales. El sexo se relaciona significativamente con el desencadenante del intento de autolisis (p 0,042) y con el diagnóstico psiquiátrico previo (p 0,011). La procedencia geográfica se relaciona significativamente con el método de autolisis (p 0,000). Conclusiones. A la hora de elaborar la historia clínica debe mejorarse la cumplimentación de los factores de riesgo de suicidio. Deben establecerse protocolos asistenciales multidisciplinares no solo para el tratamiento médico sino para la valoración urgente por el psiquiatra en nuestro centro de referencia (AU)

Objective. The aim of this study is to determine the sociodemographic and psychopathological features and risk factors associated with suicide attempts. Design. A descriptive cross-sectional study based on medical records. Emergency Primary Care Centres (Jumilla, Yecla) and Hospital Emergency Departments (Yecla, Murcia, Spain). Results. The suicide attempt rate increases in younger people (average of 36.4 years old). Suicide attempts are higher among women (67%). In terms of psychopathological data, suicide attempts were characterised by a higher prevalence of depression and anxiety disorder (30%), and substance abuse (13%). The percentage of patients who had made a previous suicide attempt was 37%. Self-poisoning was the most recurrent method of suicide attempt, present in at least 80% of the cases. Gender was a significant factor in the cause of suicide attempt (P=.042) and psychopathology (P=.011). The geographic origin of the patient is significantly associated with the suicide method used (P=.000). Conclusions. Suicide treatment protocols and suicide prevention programs must be developed, as well as recording the risk factors in the patient history (AU)

Calidad del registro de la información acerca del consumo de antiinflamatorios y analgésicos en la Historia clínica del Centro de Salud / Quality recording of information in the Health Centre medical records on the use of analgesic and anti-inflammatory drugs

Introducción. Analizar en las historias clínicas de un centro de salud la existencia o no de datos acerca del proceso de información sobre los efectos secundarios e interacciones de los analgésicos y antiinflamatorios en una población, y establecer asimismo el perfil de los pacientes respecto a la existencia o no de información a este respecto en su historia clínica. La historia clínica no es solo un documento que nos exige la ley, sino que es o debe ser una herramienta asistencial de primer orden, que facilita y ayuda en el proceso asistencial. La cumplimentación adecuada de las historias clínicas es una obligación del profesional además de ser nuestra herramienta de trabajo, pero en la historia clínica de atención primaria no siempre se registra la información generada durante la práctica asistencial. Material y métodos. Estudio descriptivo, transversal. Se revisaron las historias clínicas de 232 pacientes pertenecientes a los 8 cupos informatizados del centro de salud, mayores de 18 años y que dieron su consentimiento verbal para la inclusión en el estudio, pertenecientes al Centro de Salud Mariano Yago de Yecla (ÁreaV, comunidad de Murcia). Resultados. El 21,6% de los facultativos anota en la historia que proporciona información sobre los efectos secundarios e incompatibilidades de la prescripción de analgésicos y antiinflamatorios. Los factores que se relacionan con la ausencia de haber proporcionado información en la historia clínica son: el tipo de prescripción, el tipo de analgésico y antiinflamatorio prescritos, las variables sobre la función renal y el cumplimiento de la gastroprotección. Conclusiones. En las historias clínicas faltan registros sobre la información que se proporciona al paciente consumidor de analgésicos y antiinflamatorios (AU)

Introduction. To examine medical records within a health centre to determine whether there are data in the information process on the secondary effects and interactions of analgesic and anti-inflammatory drugs, and to determine the patient profile as regards whether or not this information is recorded in their medical records. Material and methods. Descriptive, cross-sectional study based on electronic medical records in the Mariano Yago Primary Care Centre in Yecla (Murcia), Spain. A systematic random sample of 232 electronic medical records was reviewed. All the 232 patients, of legal age, gave their consent to review of their electronic medical records for the purposes of the study. Results. The percentage of doctors who recorded the fact that they had provided information regarding secondary effects and non-compatibilities of the prescription of analgesic and anti-inflammatory drugs was 21.6%. The factors involved in the non- recording of this information in the medical record were the type of prescription, the type of analgesic and anti-inflammatory drug prescribed, glomerular filtration, and adequate gastrointestinal protection. Conclusions. The degree of compliance to patients rights to information about treatment with analgesic and anti-inflammatory drugs is low (AU)

[Quality recording of information in the health centre medical records on the use of analgesic and anti-inflammatory drugs]. / Calidad del registro de la información acerca del consumo de antiinflamatorios y analgésicos en la Historia clínica del Centro de Salud.

INTRODUCTION: To examine medical records within a health centre to determine whether there are data in the information process on the secondary effects and interactions of analgesic and anti-inflammatory drugs, and to determine the patient profile as regards whether or not this information is recorded in their medical records. MATERIAL AND METHODS: Descriptive, cross-sectional study based on electronic medical records in the Mariano Yago Primary Care Centre in Yecla (Murcia), Spain. A systematic random sample of 232 electronic medical records was reviewed. All the 232 patients, of legal age, gave their consent to review of their electronic medical records for the purposes of the study. RESULTS: The percentage of doctors who recorded the fact that they had provided information regarding secondary effects and non-compatibilities of the prescription of analgesic and antiinflammatory drugs was 21.6%. The factors involved in the non- recording of this information in the medical record were the type of prescription, the type of analgesic and anti-inflammatory drug prescribed, glomerular filtration, and adequate gastrointestinal protection. CONCLUSIONS: The degree of compliance to patients rights to information about treatment with analgesic and anti-inflammatory drugs is low.

Analysis of ionic ratios in the interventricular wall and their relation with cardiac damage as seen in anatomo-pathological and cardiac biomarkers.

UNLABELLED: In the present work, we have compared the behaviour of some commonly used markers for the immunohistochemical diagnosis of cardiac suffering (myoglobin, myosin, troponin I), with the modifications of the ionic quotients (K(+)/Na(+), Ca(2+)/Mg(2+) and Ca(2+)/Zn(2+)) that are observed in the interventricular partition in different causes of death. MATERIALS AND METHOD: we have studied a total of 50 hearts coming from autopsies carried out in the Legal Medicine Institute of Murcia (Spain) deceased 21 by natural cardiac deaths, 9 by mechanical asphyxias, 5 by politraumatism, 5 cardiac ruptures and 10 by craneoencephalic trauma. For the biochemical analysis, samples were taken from weave of 0.5 g of the interventricular partition, the corresponding dilutions were made in bidistilled water for flame atomic absorption spectrophotometry with a hollow cathode multielement lamp. For the immunohistochemical study, samples were taken from the same locations, kept in tamponed formol, dyed with hematoxylin-eosin and later 3 microm-sections were practised, antigenic recovery by heat, in pressure cooker. Our results show the existence of a statistically significant relation between the modifications of the K(+)/Na(+) quotient and the found values of troponin, which confirms its utility for the precocious diagnosis of the cardiac ischemia.

Association between immunohistochemical markers of myocardial damage and apoptosis.

Cardiac disease is the most common cause of sudden unexpected death. In forensic practice there is a need for more sensitive diagnostic methods for the post-mortem diagnosis of myocardial damage. The aim of this study was to evaluate the association of the markers routinely used for the diagnosis of acute cardiac necrosis (myosin, troponin I and myoglobin with) and the presence of apoptosis, in order to evaluate the utility of apoptosis for use as a diagnostic marker during the early stage of acute myocardial damage. A positive correlation was observed between neovascularization and signs of recent and past necrosis. Not relationship was observed between age at death, post-mortem interval and apoptosis. No statistical association was found between the expression of acute cardiac necrosis markers and the presence of apoptosis.

Histological findings and immunohistochemical surfactant protein A (SP-A) expression in asphyxia: its application in the diagnosis of drowning.

The histopathological alterations that permit the diagnosis of death by asphyxia are very unspecific, although pulmonary alterations are of great importance in this respect. The postmortem diagnosis of drowning, particularly, continues to be one of the most difficult in forensic pathology. The aim of this study is to jointly evaluate microscopic findings and immunohistochemical surfactant protein A (SP-A) expression in the upper and lower lobes of lungs in different causes of death, and their possible application to the diagnosis of drowning. We studied 120 cadavers from subjects with a mean age of 48.73 years (SD 19.45; range 2-86 years), and with a mean post-mortem interval of 30 hours (SD 39.59; range 3-216 hours). According to the scene, cause and circumstances of death, and autopsy findings, cases were classified into groups as follows: (a) drowning (n=47); (b) other asphyxia (n=44) and (c) other causes (n=29). In the upper and lower lobes of lungs, histological studies of H&E staining and immunohistochemical surfactant protein A expression were made. The presence and severity of congestion, haemorrhage and oedema, together with immunohistochemical SP-A expression, may have a diagnostic value in differentiating asphyxia and drowning from other causes of death, and drowning from other types of asphyxia. Our findings suggest that both lobes should be investigated to establish the diagnosis, although the findings in the upper lobe might be the most important for differentiating the exact cause of death.

Expression and significance of cell immunohistochemical markers (HHF-35, CD-31, Bcl-2, P-53 and apopDETEC) in hypertrophic cardiomyopathy.

There are several hypotheses concerning the pathogenesis of hypertrophic cardiomyopathy (genetic, ischaemic, immune, inflammatory and apoptosis induction). We have studied three types of cardiomyopathy in order to observe the expression and assess the significance of different immunohistochemical markers (muscular actin, CD-31, proliferation cell nuclear antigen -PCNA-, Ki-67, and markers related with programmed cell death, bcl-2, p-53 and apopDETEC). We studied different microscopic (haematoxylin-eosin and Masson's thrichrome) and immunohistochemical parameters (streptavidin-biotin-peroxidase and "in situ" hybridisation) of forty cases: ten each of hypertensive hypertrophic cardiomyopathy, essential hypertrophic cardiomyopathy, hypertrophic cardiomyopathy in patients treated with chemotherapy and morphologically "normal" hearts. Our findings point to an absence of structural marker expression (actin and CD-31) in cases of hypoxic damage. The distribution and intensity of apoptosis markers, a seen by "in situ" hybridisation were irregular, and the rest of the markers studied showed negative results, with the exception of acridin orange (a marker of hypoxic damage). In our opinion, the above immunohistochemical markers, especially actin and CD-31, could be used for differentiating hypoxic lesions in these three types of cardiomyopathy. Moreover, it is difficult to know the significance of the apoptosis markers, because the autolysis process produces cross reactions with false positive results. We think that there is a need for new studies on DNA breakdown processes during the post-mortem interval. To avoid autolysis problems the post-mortem material needs to be as fresh as possible.

Morphological characterization of renal cell lines (BGM and VERO) exposed to low doses of lead nitrate.

The response to lead nitrate has been assessed in two cell lines of renal origin. The range of toxic concentrations was determined by Neutral Red assay after 24-h of exposure. Morphological changes in the Buffalo Green Monkey (BGM) and VERO cell lines after exposure to subcytotoxic doses (1.38 mM and 1.04 mM, respectively) equivalent to EC10 (effective concentrations 10%) of lead nitrate were evaluated at the ultrastructural level by transmission microscopy. The most notable finding in treated cells was the presence of inclusion bodies in the form of irregular granules of varying size in both cytoplasm and lysosomes. Cell membrane integrity was not affected. The number of phagolysosomes and myeline figures associated to the inclusion bodies was higher than in the control cultures. We conclude that the phagolysosomic mechanism fails to digest this metal ion and the BGM and VERO renal cell lines can be considered as useful tools for toxicological studies involving lead nitrate.

Comparison of cytopathological changes induced by mercury chloride exposure in renal cell lines (VERO and BGM).

The response to mercury chloride was assessed in two cell lines of renal origin, determining the range of toxic concentrations by Neutral Red assay after 24-h of exposure. Morphological changes in the Buffalo Green Monkey (BGM) and VERO cell lines after exposure to subcytotoxic doses (0.045 and 0.038mM, respectively) equivalent to EC10 (effective concentrations 10%) of mercury chloride were evaluated at the structural and ultrastructural level by optic, transmission and scanning microscopy. Using transmission electron microscopy, the most notable findings in treated cells were the presence of intracytoplasmic inclusion bodies and apoptotic bodies. Scanning microscopy pointed to a cell with a disrupted perinuclear region and a decreased number of surface microvilli. Similar alterations in both in vivo and in vitro experiments have been described by other authors. We conclude that BGM and VERO renal cell lines can be considered as useful tools for toxicological studies involving mercury chloride.

Morphological characterisation of BGM (Buffalo Green Monkey) cell line exposed to low doses of cadmium chloride.

Morphological changes in the Buffalo Green Monkey (BGM) cell line after exposure to a subcytotoxic dose (0.062 mM, equivalent to EC(10)-effective concentration 10%) of cadmium chloride have been evaluated. Cells were exposed for 24 h and the effects observed at the ultrastructural level by transmission and scanning microscopy. Using transmission electron microscopy, the most notable findings in treated cells were the presence of intranuclear inclusion bodies and thin intracytoplasmic granules associated to myelin figures and the presence of apoptotic bodies. Other morphological alterations included cell vacuolisation and a reduced cytoplasm volume, condensation of the mitochondria and a decreased number of cytoplasmic organelles, except lysosomes and autophagic vacuoles, which increased in number. Scanning electron microscopy pointed to a cell with a disrupted perinuclear region and a decrease in the number of surface microvilli. We conclude that the BGM cell line may be considered an useful tool for toxicological studies involving cadmium.

Histopatología cardíaca en los traumatismos torácicos cerrados / Myocardial histopathology in the closed chest trauma

En el presente trabajo, hemos realizado un estudio de los hallazgos histopatológicos en las diferentes causas de fallecimiento, estableciendo como hipótesis de trabajo el hecho de que, la fisiopatología del miocardio debe reflejar los procesos cuantitativos y cualitativos que determinan el fallecimiento, ajustándose a la naturaleza del sufrimiento isquémico y/o anóxico (localizado o generalizado) y a la duración del mismo. Hemos estudiado un total de 59 cadáveres, 43 varones y 16 mujeres, de los cuales, 40 fallecieron por causas traumáticas y los 19 restantes por causas no traumáticas. Sus edades estaban comprendidas entre los 17 y 90 años, con una edad media de 51,31 años, y una media del intervalo postmortem de 13,68 horas (DS 8,7; rango 3-59 horas). Para el estudio histopatol6gico, se tomaron muestras de tejido cardíaco procedentes de: apex, cara anterior, lateral y posterior del ventrículo izquierdo, cara lateral del ventrículo derecho y zona medial del tabique interventricular, en dos niveles diferentes del corazón. Tras la fijación de las muestras y procesado, se tiñeron con hematoxilina-eosina y con naranja de acridina. Los resultados obtenidos, se sometieron a un estudio estadístico mediante el paquete estadístico SPSS.10.0 Nuestros resultados corroboran la utilidad de la técnica de la hematoxilina eosina para detectar la existencia de patología cardíaca previa al hecho causal del fallecimiento, mientras que la del naranja de acridina es útil para detectar lesiones isquémicas en aquellas localizaciones donde los procesos de perfusión del músculo cardíaco van a verse más afectados, corroborando los hallazgos descritos en la bibliografía (AU)

Modificaciones estructurales y ultraestructurales en la mucosa gastrointestinal por acción de radicales libres. Posible efecto protector del etanol / Estructural and ultraestructural modifications in gastrointestinal mucosa mediated by free radicals. Possible protective effect by ethanol

El objetivo de este trabajo es estudiar como se modifica la estructura de la mucosa gastrointestinal al verse expuesta a radicales libre y determinar si el etanol puede disminuir los daños producidos por estos radicales libres. Para ello hemos estudiado las alteraciones histológicas (estructurales y ultraestructurales) de la mucosa gastroduodenal de ratas tratadas con el reactivo de Fenton (generador de radicales libres) con y sin etanol. Nuestros resultados muestran que a nivel estructural, el grupo de ratas a las que se administró etanol junto con el reactivo de Fenton presentaban menos lesiones de tipo inflamatorio que el grupo de animales tratados solo con el reactivo de Fenton sin etanol, lo que indica que el etanol sí amortigua la acción de estos radicales libres. Sin embargo a nivel ultraestructural no podemos hacer diferenciaciones entre los dos grupos ya que todas las lesiones encontradas son lesiones celulares inespecíficas y aparecen con igual frecuencia en los mismos. Por lo tanto, debido a la inespecificidad de las alteraciones histológicas producidas por los radicales libres, estas solo nos pueden reflejar la intensidad del daño producido pero no su etiología (AU)

Utilidad de la línea celular de origen tumoral A-Mel-3 en la evaluación de la citotoxicidad por metales pesados / Utility of A-Mel-3 tumoral cell line on the cytotoxic assessment of heavy metals

Cadmio y mercurio son los metales pesados más tóxicos y todos los seres vivos, incluido el hombre, sufren los efectos de su exposición. Las altas dosis de cadmio y de mercurio determinan alteraciones morfológicas generalmente bien conocidas. Sin embargo, al igual que ocurre con las alteraciones bioquímicas, los cambios ultraestructurales producidos por dosis subletales no están claramente definidos. Este hecho tiene una especial trascendencia ya que los seres vivos están expuestos a dosis bajas de estos metales durante toda la vida, principalmente como consecuencia de su presencia en los alimentos y en el medio ambiente. Por otro lado, la monitorización de los efectos tóxicos in vivo está dejando paso a la realización de estudios mediante técnicas in vitro. Estos estudios, que normalmente se llevan a cabo Sobre tejidos obtenidos de animales sanos, utilizan con frecuencia los análisis ultraestructurales, ya que éstos pueden ayudar a dilucidar los mecanismos de acción de dichos agentes. En el presente estudio hemos analizado los efectos in vitro que dosis subletales de metales pesados (cadmio y mercurio) producen sobre células de la línea de origen tumoral A-Mel-3 con el objetivo de estudiar los efectos de dichas dosis y la utilidad de estas células en este tipo de estudio. Previamente a los experimentos con los metales, se estudiaron las características morfológicas de las células, así como su crecimiento. Mediante el ensayo del Rojo Neutro (RN) se determinó el rango de concentraciones de cada metal con efecto sobre la viabilidad celular. Para el estudio morfológico, las células fueron expuestas a una concentración que producía una reducida pérdida de viabilidad (0-10 por ciento) así como a la, concentración con efecto máximo de cada metal (100 por ciento de pérdida de viabilidad), obtenidas por el ensayo del RN. A altas concentraciones las alteraciones estructurales producidas eran fácilmente visibles. A bajas concentraciones no encontramos alteraciones estructurales, mientras que, a nivel ultraestructural, sí se apreciaron, además de otras alteraciones, hipertrofia y tumefacción de ciertas organelas citoplásmicas (AU)

Comparación de dos métodos colorimétricos en la evaluación citotóxica de metales pesados en cultivos de células renales / Comparison of two colorimetric methods on the heavy metals cytotoxic assessment on renal cell cultures

En el presente trabajo se ha evaluado la capacidad citotóxica del plomo, cadmio y mercurio en tres líneas celulares de origen renal (BGM, VERO y PK-15). Los resultados de la exposición aguda á estos metales, se evaluaron mediante técnicas colorimétricas basadas en la exclusión de colorante vital MTT tetrazolio (MTT) y Rojo Neutro (RN). La línea PK-15 precisó un rango de concentraciones más amplio, para contrastar los efectos del plomo y mercurio, mientras que la línea BGM fue la que presentó esta característica para el cadmio. Con la técnica del RN, la citotoxicidad de todos los metales se evidenció en un rango de concentraciones más estrecho que con la técnica NITT, excepto en las combinaciones VERO-cadmio y PK(15)-mercurio. En cuanto a los metales, el plomo fue el que marcó una menor toxicidad para todas las líneas y técnicas colorimétricas. El mercurio fue el metal más tóxico en las líneas BGM y VERO y el cadmio lo fue para la línea PK-15. Se discute la utilidad de comparación del efecto citotóxico de estos metales en base a un nivel sin efecto observable (NSEO), concentración efectiva 50 (CESO), concentración efectiva 100 (CE100) y toxicidad en función de la pendiente, así como en función de la técnica colorimétrica empleada y de las líneas celulares (AU)

Medicolegal problems associated with do not resuscitate orders.

The use and potential abuse of the do not resuscitate (DNR) order has wide-ranging ethical, legal and economic implications. A DNR order is essential for clear communication between health care professionals, but the order itself may affect the care that patients subsequently receive. In addition, the DNR order may be a crucial therapeutic decision point in the care of the critically ill. Although general guidelines exist for withholding resuscitative measures from the terminally ill and general principles have been established, Spanish legislation is ambiguous on a number of points, forcing medical professionals to make difficult choices. This has led to the systematic, indiscriminate application of resuscitative measures, motivated in many cases by the desire to avoid a possible future lawsuit. We believe clearer and more precise legislation should be developed to bring Spanish criteria into line with those of international organizations that provide a common set of guidelines on important issues relating to the right to life and the right to refuse treatment.

Study of postmortem blood circulation.

The objective of this work was to study the postmortem redistribution of blood volumes and its influence of the distribution of substances of different molecular weight (194.2 and 150,000 Da). Lipiodol Ultrafluide, Omnitrast, or a radioisotopic mixture of aminohippuric acid and human IgG were injected into the left ventricle of a total of 20 rabbits divided into three groups. Our results demonstrate the importance of related factors, including left ventricular postmortem contraction, the arterial vascular bed, diffusion processes connected to the physicochemical characteristics of the substances, and the anatomical distribution of the vessels. Postmortem diffusion of aminohippuric acid to the urine was observed.

Attitudes of medical personnel (doctors and nurses) toward informing the terminal patient.

The right to be informed, an indispensable condition of informed consent for a given therapeutic intervention, results in numerous practical problems in extreme situations. The purpose of this study was to analyze the relevant attitudes of medical practitioners and nursing staff. A total of 108 doctors and 102 nurses ranging in age from 22 to 63 years (mean 29, 67; SD 8, 73) was randomly selected from personnel currently in practice in Murcia (Spain) and asked to respond to a 72 item questionnaire developed by the authors. The results underline the need to approach the doctor-patient relationship from standpoint more closely attuned to the real circumstances of medical practice.