Characteristics of falls producing hip fracture in patients on oral anticoagulants.

OBJECTIVE: To analyze the demographic and clinical characteristics of patients on chronic anticoagulant therapy (CAT) admitted because of a hip fracture secondary to a fall, and to compare with patients not receiving CAT. METHODS: A prospective, observational study realized in six hospitals in the Barcelona area. Demographic and clinical characteristics of patients were collected. The index fall characteristics - cause, height, location, and time of occurrence - were evaluated. RESULTS: Of the 1225 patients included, 99 (8%) patients were on CAT. When we compare with the rest logistic regression analysis showed that patients receiving CAT were more likely to be male (odds ratio 3.7), not institutionalized (odds ratio 3.5), to take more number of drugs (odds ratio 1.3), to have dementia (odds ratio 2.1) and stroke (odds ratio 1.7). Results revealed a higher prevalence of combined factors as the cause of the index fall in the group of patients on anticoagulants. CONCLUSIONS: Characteristics of falls were very similar when comparing the group of patients receiving CAT with those who did not. A prior history of falls should lead physicians to take actions for preventing falls causing hip fracture, in all patients and particularly in these on CAT.

Incidence and Risk Factors for Infection When Teicoplanin Is Included for Prophylaxis in Patients with Hip Fracture.

BACKGROUND: Surgical site infection (SSI) rate after surgery for hip fracture is about 4%. The aim of the present study was to review the efficacy of dual prophylaxis using teicoplanin plus cefuroxime and risk factors for SSI. PATIENTS: Operations for hip fracture from 2012 to 2013 were retrospectively reviewed. Relevant information was gathered: Demographics, comorbidities, ASA score, laterality, type of fracture, type of surgery, d from admission to surgery, length of surgery, hemoglobin value at admission, urinary or respiratory infections, and the need for pre-operative, intra-operative, and post-operative red blood cell (RBC) transfusion. Prophylaxis consisted of cefuroxime and teicoplanin during the induction of anesthesia. U.S. Centers for Disease Control and Prevention (CDC) criteria for superficial and deep SSI were applied. Univariate and multivariable analysis were performed. RESULTS: Six hundred fifty-seven patients were included in the study. Thirteen (2.0%) SSI were identified, six superficial (0.9%), and seven deep (1.1%). Staphylococcus aureus was isolated in two infections (one superficial and one deep). The SSI rate was 2.4% in intra-medullary nails (n = 334), 1.4% in prostheses (n = 211), and 1.8% in other synthesis (n = 112). Parameters independently associated with SSI were: Intra-operative RBC transfusion (OR: 11.6, p = 0.002), length of surgery >120 min (OR: 4.5, p = 0.02), and having a urinary infection (OR: 4.28, p = 0.02). CONCLUSION: Dual prophylaxis including cefuroxime and teicoplanin was associated with a 2% rate of SSI. Staphylococcus aureus caused only two SSIs. Reducing SSI is of utmost importance for patients' quality of life and to avoid additional cost of surgical procedures. Therefore, more experience with dual prophylaxis is needed to confirm our results.

Clinical evidence of diabetes mellitus end-organ damage as risk factor for falls complicated by hip fracture: A multi-center study of 1225 patients.

AIMS: To identify the differential characteristics of patients with type 2 diabetes mellitus (T2DM) complicated by end-organ damage who experience a fall-related hip fracture. METHODS: We analyzed the socio-demographic data and index fall clinical characteristics of a group of patients with nephropathy, neuropathy or retinopathy related to T2DM consecutively admitted to six hospitals in Barcelona, Spain because of a fall-related hip fracture. RESULTS: Out of 1225 patients admitted because of a fall-related hip fracture, 107 (8.7%) had clinical evidence of end-organ damage related to T2DM. Among this cohort the mean number of falls during the year prior to the index admission was 2.6±3.2; and 29 of them (27.1%) had already experienced three or more falls. Most falls leading to the index admission took place at the patients' home, from a standing position, and during daylight time. An intrinsic cause of falling was identified in all but one of these patients. Multiple stepwise logistic regression analysis showed that, compared to patients without this diagnosis, patients with complicated T2DM were younger (odds ratio 0.762), had less prevalence of dementia (odds ratio 0.078), but had experienced a higher number of falls in the previous year (odds 1.183). CONCLUSIONS: A significant amount of patients with clinical evidence of end-organ damage due to T2DM who experience a fall-related hip fracture have a history of recurrent falling in the previous year. These patients should be identified and offered preventive actions aimed at reducing their risk of falling.

Estrés y sistema inmune en obreras de maquiladoras hondureñas / Stress and the immune system in Honduran maquiladora workers

Numerosos estudios señalan a la industria maquiladora como espacio de procesos productivos precarios, carente de derechos laborales, caracterizado por uso intensivo de mano de obra femenina y vinculado con afectación a la salud de las obreras. Es elevada la cantidad de estas industrias en países de Centroamérica, entre ellos Honduras, y la salud de sus trabajadoras se ha visto afectada. La exposición prolongada a condiciones estresantes repercute sobre diversos sistemas corporales, entre ellos el inmune. Esta investigación analiza la relación entre condiciones de trabajo estresantes y alteraciones en el sistema inmune de obreras de la maquila hondureña. Se aplicaron encuestas a 199 trabajadoras para identificar condiciones de trabajo potencialmente estresantes y daños a la salud. Se identificó presencia de estrés y su repercusión sobre el sistema inmune, con medición de anticuerpos en suero. Se midieron inmunoglobulinas IgG, IgA e IgM por método turbidimétrico en 98 trabajadoras. Se efectuó análisis bivariado con el programa Statcalc. Se reportó multiexposición a condiciones estresantes. 83% de trabajadoras presentaron estrés. Se encontró disminución de inmunoglobulinas en varias trabajadoras (12,24%). Se esperaba que ninguna presentara disminución, pues en población general sólo una de cada 1000 personas la tiene. La presencia de padecimientos relacionados con condiciones estresantes, comunes en las industrias maquiladoras, hace urgente la aplicación de medidas que corrijan esas condiciones para evitar daños a la salud de obreras de la maquila. La disminución de inmunoglobulinas debe tomarse en cuenta para reflexionar acerca del impacto de las condiciones nocivas de trabajo e implementar medidas de prevención.

Numerous studies point to the maquiladora industry as an area of unstable production processes, devoid of labor rights, characterized by intensive use of female labor and associated with adverse effects on health of workers. There are a large number of these industries in Central American countries, including Honduras, and the health of their workers has been affected. Prolonged exposure to stressful conditions can impact various body systems, including the immune system. This research analyzes the relationship between stressful working conditions and alterations in the immune system of Honduran maquiladora workers. Surveys were completed by 199 workers to identify potentially stressful working conditions and adverse health effects. We identified the presence of stress (stress symptom scale) and its impact on the immune system through measurement of serum antibodies. We measured IgG, IgA and IgM by the turbidimetric method in 98 workers. Bivariate analysis was performed with the program Statcalc. Multiple exposures to stressful conditions were reported. 83% of workers had stress. Decreases in immunoglobulin levels were found in 12.24% of workers. This was unexpected, as only 1 in 1000 persons in the general population present any decrease in immunoglobulin levels. The presence of conditions associated with stressful conditions, common in the maquiladora industry, makes it urgent to correct these conditions and prevent adverse health effects among female workers. The observed decrease in immunoglobulin levels should be considered when assessing the impact of harmful conditions of work and in the implementation of preventive measures.

Trabajo, estrés y salud: la costura a domicilio en Ciudad de México / Work, stress and health: domestic seamstresses and tailors in Mexico City

Las personas que laboran en la costura enfrentan condiciones de trabajo y de vida precarias, el trabajo a domicilio intensifica la nocividad de sus procesos, por lo cual se ven forzadas a desempeñarse en condiciones laborales que repercuten negativamente en su salud. En este estudio, se planteó identificar condiciones de trabajo nocivas, potencialmente estresantes y su asociación con los daños a la salud en un grupo dedicado a las labores de la costura en México, D.F.. Se aplicaron 138 encuestas con información demográfica, socioeconómica, de riesgos y exigencias laborales y salud. Se aplicó un cuestionario de estrés, otro de carga de trabajo doméstica y una guía de observación de proceso de trabajo. Se realizó análisis univariado y bivariado. Fueron entrevistados 26 varones y 112 mujeres con edad promedio de 40.8 años (DS±10.3). Se reportaron diversos riesgos y exigencias potencialmente estresantes. La tasa de morbilidad fue de 390 daños (por cada 100). Los padecimientos más frecuentes fueron conjuntivitis crónica, várices, lumbalgia, trastornos musculoesqueléticos, fatiga crónica, cefalea, ansiedad, trastornos del sueño, hipoacusia, rinofaringitis crónica, depresión, hemorroides y dermatitis. El estrés mostró una prevalencia de 23 (por cada 100). Se encontraron, entre otras asociaciones significativas: posiciones incómodas y asiento incómodo con lumbalgia, repetitividad y trabajo pesado con fatiga crónica, trabajo aburrido con depresión y jornada prolongada; la jornada prolongada, la exposición a ruido, la repetitividad y no poder desatender su tarea más de 5 minutos se asoció con estrés. Se concluye que los padecimientos identificados se encuentran relacionados con condiciones de trabajo; son urgentes medidas ergonómicas y organizacionales, rediseño del puesto y cobertura de servicios de salud.

People who work in sewing face precarious working and living conditions; the domestic setting of this work increases harm, as many workers are subjected to working conditions that can adversely affect their health. The aim of this study was to identify hazardous and potentially stressful working conditions and their association with adverse health outcomes in a group of seamstresses and tailors in Mexico City. One hundred thirty-eight surveys were administered, centered on demographic, socioeconomic, and occupational risk factors, together with job demands and health. We applied a stress questionnaire, a domestic workload questionnaire and a guide to observe the work process. We performed univariate and bivariate analysis. We interviewed 26 men and 112 women; mean age was 40.8 years (SD ± 10.3). Several occupational risks and potentially stressful demands were reported; morbidity was 390 incidents per 100 workers. The most common adverse health effects were chronic conjunctivitis, varicose veins, back pain, musculoskeletal disorders, chronic fatigue, headache, anxiety, sleep disorders, hearing loss, chronic nasopharyngitis, depression, hemorrhoids, and dermatitis. The prevalence of stress was 23 per 100 workers. Among others, the following statistically significant associations were found: prolonged awkward positions and uncomfortable seating with back pain, repetitive and heavy work with chronic fatigue, monotonous work with depression; long working hours, exposure to noise, repetitiveness and inability to be away from work for more than 5 minutes was associated with stress. We conclude that these adverse health effects are associated with poor working conditions. Interventions targeted at work organization, ergonomics, job redesign and better coverage of health services are urgently needed.

Thiadiazine derivatives as antiprotozoal new drugs.

The 3,5-disubstituted tetrahydro-2H-1,3,5-thiadiazine-2-thione scaffold have found many applications in recent years. This review is aimed at highlighting the most important aspects about these compounds: synthesis, spectroscopic characterization and antiprotozoan activities. How the chemical nature of N-substituents influences the overall activity / cytotoxicity profile will also be discussed.

Necesidades insatisfechas de atención odontológica en trabajadores de la costura en México DF / Unmet needs for dental care in garment workers in Mexico City

La salud bucal de los trabajadores no recibe interés suficiente en estudios sobre salud laboral, problemas dentales se suman a sus perfiles patológicos agravándose cuando no tienen una atención odontológica oportuna. Se realizó un estudio transversal, entre trabajadores de la costura en México, D.F., cuyo objetivo fue estimar la prevalencia de caries, higiene bucal y pérdida de dientes asociándola con condiciones socioeconómicas, laborales, acceso a servicios dentales y autopercepción de salud bucal. Se aplicó un cuestionario a 93 trabajadores que fueron examinados usando los criterios de la Organización Mundial de la Salud (OMS), respecto al índice CPOD que mide el promedio de dientes cariados, perdidos y obturados, obteniendo los siguientes resultados: 85% fue del género femenino, la edad de 14 a 64 años con una media y DS de 41.56 ± 10.7. El índice CPOD alcanzó 13,7 siendo más alto 17,56 para los de 55-64 años, asociándose los dientes perdidos con edad, ser mujer y el número de hijos (p < 0.05). La visita al dentista durante los últimos 12 meses fue por dolor en 38,7%, a un dentista privado 62%, asociándose con escolaridad y mejores ingresos (p < 0.05). La autopercepción de su salud bucal fue mala y muy mala en 48,5% relacionándose con dientes cariados (p < 0.05). Se concluyó que el CPOD y los dientes perdidos aumentaron conforme la edad, siendo junto con dientes cariados los valores más altos del índice. Se identificaron necesidades no atendidas y peores condiciones de salud bucal en mujeres.

Oral health has not been adequately addressed in occupational health. Dental caries and treatment needs affect low income workers, particularly those with no suitable access to dental services. We estimated the prevalence of dental caries, poor oral hygiene and tooth loss in garment workers in Mexico City, and examined their association with socioecomic status, employment and self-perceived oral health. This was a cross-sectional survey of 93 participants who completed a questionnaire. Oral examination was performed following standards recommended by the World Health Organization. Dentition status and treatment needs were calculated, along with counts of decayed, missing and filled teeth (DMFT). The age ranged from 14 to 64 years (mean ± SD, 41.56 ± 10.7); 85% of subjects were women. Mean DMFT for all age groups was 13.7, with the highest mean (17.64) being in the 55 to 64 year age group. The missing tooth component was related to age, being a woman and number of children (p < 0.05). Tooth pain was the main reason to visit a dentist (38.7%); 62% sought care through a private dentist and this was closely associated with a higher level of education and income (p < 0.05). Oral health was self-perceived as bad or very bad in 48.5% of cases and was associated with decayed tooth component. Mean DMFT and missing teeth increased with age; missing and decayed teeth had the highest scores within the DMFT. These findings indicate that the dental treatment needs of the study population are unmet and that this situation is worse among women.

Condiciones de trabajo, Estrés y Daños a la salud en trabajadoras de la maquila en Honduras / Working conditions, stress and adverse health effects among female maquiladora workers in Honduras

Se analizan las condiciones de trabajo de las obreras de la maquila de San Pedro Sula, Honduras, así como la presencia de estrés y daños a la salud en estas trabajadoras. Se llevó a cabo un estudio de tipo transversal por medio de la aplicación de tres instrumentos: una guía de observación del proceso de trabajo, una encuesta individual y la Escala sintomática de estrés. Los resultados muestran una elevada exposición a riesgos y exigencias, así como tasas altas de daños a la salud. Destaca la presencia importante de estrés en las trabajadoras. La elevada frecuencia de daños a la salud, entre los que se encuentra fatiga crónica, depresión, ansiedad, trastornos musculoesqueléticos, entre otros, está asociada a la alta exposición a riesgos y exigencias que imponen las formas de organización y división del trabajo a las obreras en este tipo de industrias

This paper describes working conditions in the export-oriented “maquiladora” industry in San Pedro Sula, Honduras, and the presence of stress and adverse health effects in women workers. A cross-sectional study was conducted, using three instruments: a guide for observation of work processes, an individual health symptom survey and a stress symptom scale. Results revealed a high prevalence of exposure to occupational risk factors and job demands, as well as high rates of stress and adverse effects on health. Chronic fatigue, depression, anxiety, musculoskeletal disorders, among others, are associated with high exposures to workplace risk factors and job demands due to the organization and division of labor in these industries

Characteristics of fall-related hip fractures in community-dwelling elderly patients according to cognitive status.

BACKGROUND AND AIMS: Falls are a major cause of morbidity and mortality in older people who have cognitive impairment. The present study compared the characteristics of community-dwelling patients, with and without previous diagnosis of dementia, hospitalized because of a hip fracture. METHODS: 1024 consecutive patients >65 years (77.2% women, mean age 82.9 yrs) admitted for fall-related hip fracture to six Spanish hospitals during a 20-month period were included. Sociodemographic data, geriatric assessment and characteristics (location, time and possible cause: intrinsic, extrinsic or combined risk factor) of falls leading to hip fracture were evaluated. RESULTS: A total of 154 (15%) patients had a previous diagnosis of dementia. Analysis showed a greater number of previous falls before admission for hip fracture in demented patients. Moreover, in non-demented patients, we found both a predominance of falls during the day and of extrinsic factors. CONCLUSION: Some differences were observed, according to the cognitive status of elderly patients suffering a hip fracture due to a fall. A high percentage of dementia patients had suffered repeated falls prior to the fall-related hip fracture.

Factors associated with hip fracture-related falls among patients with a history of recurrent falling.

BACKGROUND: People who have suffered falls are at greater risk of falling again. We study the characteristics of falls leading to hip fracture in people with a history of recurrent falls, comparing them with those of people with a history of sporadic falling. MATERIALS AND METHODS: Analysis of the characteristics of a sample of 1225 patients consecutively admitted to six hospitals because of a hip fracture secondary to a fall (index fall) - index fall characteristics (location, time and the possible cause of the fall: intrinsic, extrinsic or combined risk factors) were also determined. Patients with a history of three or more falls (recurrent fallers) in the year prior to the index fall were identified as high-risk fallers; those with less than three falls were considered to be sporadic fallers. RESULTS: The mean number of falls in the year prior to the index fall was 1.7+/-6.5; 227 patients (22%) had experienced three or more falls within that period. Most index falls (880, 71.8%) took place at the patient's home, 232 (18.95%) in the street and 113 (9.2%) elsewhere; most (892, 72.9%) took place during daytime. Multiple stepwise logistic regression analysis showed that recurrent fallers were characterized by poorer baseline independence for activities of the daily living, a prior diagnosis of dementia, greater use of prescription drugs and a greater use of neuroleptics. For frequent fallers, the index fall was more often associated with an intrinsic factor than for sporadic fallers. CONCLUSIONS: A significant percentage of patients experiencing a fall followed by hip fracture have a history of recurrent falling in the year prior to a fall-related hip fracture. Poorer functional and cognitive status, polypharmacy and the use of neuroleptics are more prevalent in this subgroup of patients, and intrinsic factors as a cause of the fall are more common in this group. Whether these circumstances associated with recurrent falling are responsible for this higher prevalence of intrinsic, non-accidental falls should be addressed prospectively in order to implement preventive strategies.

Hospital deaths of people aged 90 and over: end-of-life palliative care management.

BACKGROUND: In developed countries, hospital deaths at very advanced age are increasingly common. Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases. OBJECTIVE: To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients. METHODS: We conducted a prospective assessment in two teaching hospitals of the written instructions for the following actions: do not resuscitate (DNR) orders, the graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of normal drug therapy and provision of palliative care. RESULTS: 80 patients over 89 years of age with end-stage congestive heart failure (57.5%) or dementia (42.5%) were included. The control group comprised 52 younger patients (65-74 years). DNR orders were specified in 56% of cases, graduation of therapeutic decisions in 35%, and knowledge of relatives regarding the prognosis in 61%. Drug therapy was withdrawn in 66% of cases and terminal palliative care was initiated in 69%. In the nonagenarians who died, we detected a predominance of females (p = 0.001), a higher percentage of DNR orders (p = 0.02) and a higher percentage of graduation of therapeutic measures (p = 0.02) in comparison with younger patients. CONCLUSION: Our results indicate that there are marked differences according the palliative care provided to oldest-old patients with end-stage non-cancer chronic diseases admitted to an acute care hospital. In any case, care should be improved for both age groups.

La dislipemia en la población anciana / No disponible

Diversos estudios epidemiológicos y de intervención han establecido de forma clara la relación entre la hipercolesterolemia y el riesgo de padecer una enfermedad cardiovascular arteriosclerótica. De la misma manera, tratamiento con estatinas ha demostrado un beneficio en la prevención primaria y secundaria de enfermedad cardiovascular. Los ensayos clínicos que han incluido población de 65-80 años no son numerosos pero en este grupo de población también se establece una claro beneficio cardiovascular con el tratamiento con estatinas. De hecho, la arteriosclerosis es un fenómeno casi inseparable del envejecimiento y es lógico pensar que la hipercolesterolemia también es un factor de riesgo en la población anciana. En relación con la población de edad superior a 80 años no existen estudios disponibles en la actualidad y la información que se maneja en la práctica clínica se basa en la extrapolación de datos obtenidos en población más joven. El tratamiento hipolipemiante en la población anciana estaría justificado, al menos, hasta los 80 años. Obviamente, el planteamiento de inicio del tratamiento hipolipemiante estaría en función de su calidad de vida previa, de su esperanza de vida y de su situación de riesgo cardiovascular (AU)

Several epidemiological and clinical trials have well established the relationship between hypercholesterolemia and the risk of developing a cardiovascular disease. In the same way, statin therapy have shown a beneficial effect on primary and secondary cardiovascular prevention. There are a small number of elderly people, aged 65-80 years, included in clinical trials with statins but the results have shown the efficacy and usefulness of treating hypercholesterolemia in the elderly. With relation to very elderly people, aged >80, there are no data. The use of hypolipemic drug treatment in elderly people is justified at least until the 80 years. It is important to notice that the decision of treating hyperlipidemia depends on previous quality of life, life expentancy, and risk of cardiovascular disease (AU)

Differences in the characteristics of elderly patients suffering from hip fracture due to falls according to place of residence.

OBJECTIVES: To examine whether the characteristics of patients hospitalized for hip fracture differed according to whether they lived in institutional or community residences. DESIGN: Prospective cohort study. SETTING: Six hospitals in the Barcelona area, Spain. PARTICIPANTS: 872 consecutive patients (75.8% women, mean age 82.5 years) admitted for fall-related hip fracture. MEASUREMENTS: Sociodemographic data, geriatric assessment, and characteristics (location, time and possible cause: intrinsic, extrinsic, or combined risk factor) of falls leading to hip fracture. RESULTS: A total of 724 (83%) patients were living in the community and 148 were institutionalized. Multivariate analysis showed a predominance of female sex, married status, and better Barthel Index values and Charlson comorbidity scores among community-dwelling patients. In contrast, institutionalized patients were more often male and widowed, had more dementia and visual deficits, and presented higher levels of both total and psychoactive drug consumption. Although both groups fell more often in their place of residence, the proportion of community-dwelling patients falling in an exterior location was significantly higher. A history of previous falls was more common among institutionalized subjects. CONCLUSION: In elderly patients suffering a hip fracture due to a fall there are some differences according to the place of residence. A high percentage of patients had suffered repeated falls.

La hipertensión arterial en la población anciana / No disponible

Se estima que la prevalencia de hipertensión arterial (HTA) en la población española de edad>60 años es superior al 65%. Es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular, y que ésta sigue siendo la primera causa de muerte en la población occidental. La necesidad de tratamiento de la HTA en la población anciana es un hecho ya ampliamente demostrado y se asocia a una reducción del riesgo de presentar una complicación cardiovascular. Sin embargo, el tratamiento de la HTA en el anciano puede resultar una tarea complicada por la necesidad de tener presente en su manejo clínico una serie de características propias de este grupo de pacientes, como son una farmacocinética alterada, la comorbilidad, o la polifarmacia. Por otra parte, todavía no existen estudios suficientes en el caso de la población más anciana (>85 años) y, en este sentido, el tratamiento individualizado es el que debiera realizarse en nuestra práctica clínica habitual (AU)

The prevalence of essential hypertension in Spanish population elder than 60 years is about 65%. It is known that essential hypertension is the most important risk factor for developing a cardiovascular disease. Cardiovascular diseases continue to be the leading causes of illness and death among adults from developed countries. Several studies have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. However, managing of high blood pressure in elderly population can be difficult since most of these people have comorbidities that could influence the therapy. On the other hand there are some issues that remainsunanswered in this group of population, such as how aggressively these patients should betreated, and also evidence enough for treating oldest old patients (AU)

Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers.

BACKGROUND: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver's opinions about the death. METHODS: Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver's opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. RESULTS: Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. CONCLUSION: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.

Síntesis de nuevos derivados de hexahidroquinoleínas y evaluación farmacológica de sus propiedades antagonistas del calcio / Synthesis of new hexahydroquinoline derivatives and pharmacological evaluation of their calcium antagonist properties

Se prepararon cinco hexahidroquinoleínas por una síntesis en un solo paso, a partir de un aldehído aromático, el ß -aminocrotonato de alquilo (enamina) y dimedona en etanol absoluto como disolvente. Se caracterizaron los efectos de las cinco hexahidroquinoleínas sobre la contractilidad en anillos de aorta de conejo y sobre la contractilidad de músculos papilares de ventrículo derecho de rata, de manera comparativa con la clásica nifedipina. Todas las hexahidroquinoleínas inhibieron la actividad contráctil tanto en músculo liso vascular como en músculo cardíaco, y mostraron efectos característicos de compuestos antagonistas del calcio, aunque con menor potencia de acción que la nifedipina. Sin embargo, dos de las hexahidroquinoleínas estudiadas presentaron cierta vasoselectividad, aunque no marcada(AU)

Síntesis de nuevos derivados de hexahidroquinoleínas y evaluación farmacológica de sus propiedades antagonistas del calcio / Synthesis of new hexahydroquinoline derivatives and pharmacological evaluation of their calcium antagonist properties

Se prepararon cinco hexahidroquinoleínas por una síntesis en un solo paso, a partir de un aldehído aromático, el ß -aminocrotonato de alquilo (enamina) y dimedona en etanol absoluto como disolvente. Se caracterizaron los efectos de las cinco hexahidroquinoleínas sobre la contractilidad en anillos de aorta de conejo y sobre la contractilidad de músculos papilares de ventrículo derecho de rata, de manera comparativa con la clásica nifedipina. Todas las hexahidroquinoleínas inhibieron la actividad contráctil tanto en músculo liso vascular como en músculo cardíaco, y mostraron efectos característicos de compuestos antagonistas del calcio, aunque con menor potencia de acción que la nifedipina. Sin embargo, dos de las hexahidroquinoleínas estudiadas presentaron cierta vasoselectividad, aunque no marcada