Chronic benzodiazepine usage among older people: prevalence, indications, and treatment modifications in patients admitted to an acute geriatric unit.

AIM: To investigate the prevalence and indications of benzodiazepines (BZD) usage among patients admitted to an acute geriatric unit and assess changes in prescriptions. METHODS: BZD indications were documented reviewing clinical records, with appropriateness assessed based on the STOPP-START criteria. Changes in BZD prescriptions were recorded at discharge and 3 months later. RESULTS: Among the 366 patients included (mean age: 92.8 years, 68% females), 91 (24.9%) were on BZD upon admission, being inappropriate in 93.4%. At discharge, BZD discontinuation was observed in 40.7% and dose reduction initiated in 57.4%. Among patients discharged without prescriptions, 10.8% resumed their use at 3 months. Of those discharged with BZD tapering, 74.1% were still on them 3 months later. CONCLUSIONS: The majority of patients employing BZD lacked a medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction for most patients but was not maintained in the outpatient setting.

Photodegradation of 2,4-D (dichlorophenoxyacetic acid) with Rh/TiO2; comparative study with other noble metals (Ru, Pt, and Au).

In this work the effect of noble metal on the photodegradation of 2,4-dichlorophenoxyacetic acid herbicide using TiO2 as support was studied. The metals and concentration were: Rh, Ru, Pt and Au and 1, 0.98, 1.89, and 1.91 wt% respectively. Rhodium was taken as reference for this experiment. The samples were characterized by X-Ray Diffraction (XRD), UV-vis absorption spectra, N2 physisorption (BET Specific Surface Area), High Annular Angle Analysis Darkfield (HAADF) and Transmission Electron Microscopy Scanning (STEM), H2 chemisorption, optical emission spectroscopy with inductive coupling plasma analysis (ICP-OES), solid fluorescence, X-ray Photoelectron Spectroscopy (XPS) and OH quantification. The presence of the anatase crystalline phase was mostly confirmed in all samples. The band gap decreased with the presence of metal (from 3.24 to 2.92 eV). The specific area was a function of the metal particle size. The metal particle diameter showed the following sequence Pt > Ru > Au > Rh. By XPS, TiO2 does not manifest changes in oxidation states, but when impregnated with metals, only Pt shows the highest abundance of any oxidized state (Pt2+). The presence of metal reveals less electron-hole recombination compared with titanium oxide. The results of photocatalytic activity showed that Pt and Rh are the two metals with the highest mineralization (99.0 and 98.3%, respectively).

Effect of the CuAl2O4 and CuAlO2 Phases in Catalytic Wet Air Oxidation of ETBE and TAME using CuO/γ-Al2O3 catalysts.

This paper studies Cu/Al2O3 catalysts, synthesized in two ways: copper deposit in the synthesis of alumina (sol gel) and incipient impregnation stabilized at 400 °C. The materials were characterized by X-ray diffraction studies, nitrogen physisorption, temperature programmed reduction of H2, dehydration of isopropanol, scanning electronic microscopy, transmission electronic microscopy, which were evaluated in the liquid phase oxidation reaction of ethyl tert-butyl ether and tert-amyl methyl ether. The formation of CuAl2O4 and CuAlO2 in the samples synthesized by sol gel, led to a modification of the texture, thus resulting in an expansion of the specific area of the materials. CuAl2O4 and CuAlO2 have been identified by DRX from a content of 10 % Copper, the first showed the highest intensity with this technique. In the same way, these species favor the presence of Lewis acid sites; this is reflected in the materials with (Di-isopropyl Ether) DIPE of 96.7 % and 91.1 % for the samples SAlCu5 and SAlCu15 respectively. The catalytic activity of the materials prepared by sol gel is in the function of the number of surface acid sites, the smaller particle size of the Cu and the surface of the contact, in the case of the ETBE meanwhile for TAME the activity was based mainly on the strength of the present acid sites. With impregnated materials, the activity is attributed to the smaller particle size of the Cu and the greater strength of the surface acid sites in the solid. The formation of spinel species inhibits the leaching phenomenon in the reaction milieu.

No changes on viral load and CD4+ T-cell counts following immunization with 7-valent pneumococcal conjugate vaccine among HIV-infected adults in Malawi.

Vaccination has been associated with a transient increase in viremia in HIV-infected individuals, although contradicting evidence persist in the literature. As part of a randomized placebo-controlled efficacy trial of the PCV7 in Malawi, we collected viral load and CD4+ T-cell counts from 237 adults who received two doses of vaccine or placebo, administered 4 weeks apart. Analyses were conducted separately for cART and non-cART users. Our analysis show no difference in viral loads between vaccine and placebo groups, regardless of cART use. Viremia decreased from 4.1 to 2.9 log10 copies/mL (p < 0.0001) among those using cART, consistent vaccine and placebo groups, but no changes were seen among the non-cART cohort. CD4+ T-cell counts remained unchanged regardless of cART use, or allocation to vaccine or placebo. We concluded that there was no evidence of detrimental effects of PCV7 administration on viral load or CD4+ T-cell counts six months after vaccination with PCV7.

Soil-transmitted Helminth Infections in Schoolchildren of Laguna de Perlas (Nicaragua).

Soil-transmitted helminth (STH) prevalence, intensity, polyparasitism and co-infections in 425 children from 3 schools of Laguna de Perlas (Nicaragua) were investigated. Single stool samples were analysed by the formalin-ether method and the Kato-Katz. A total of 402 (94.6%) children were infected. Trichuris trichiura 308 (72.4%), Ascaris lumbricoides 115 (27.1%) and Hookworms 54 (12.7%) were the most prevalent STHs. Polyparasitism (322; 75.8%) with two species was most prevalent (109; 25.6%). T. trichiura with A. lumbricoides (19.3%) and T. trichiura with Hookworm (6.8%) were the most common combinations. Positive associations were observed between T. trichiura and A. lumbricoides and T. trichiura and Hookworm (p = 0.0001). Highest Hookworm intensities appeared when three STH co-infections occurred. Moderate- heavy STH intensities appear in up to 42.1% in trichuriasis, 57.5% in ascariasis and 11.1% in Hookworm infections. Integrated control interventions covering children need to be implemented mainly in a rural environment.

Pilot study of the completeness of notification of adult tuberculosis in Athens, Greece.

SETTING: Sotiria Chest Diseases Hospital (SCDH), a referral hospital in Athens, Greece, 2012. OBJECTIVE: To assess the completeness of the mandatory notification system for tuberculosis (TB) at the SCDH, and compare the observed and estimated annual incidence rates. DESIGN: Record linkage and the capture-recapture method were applied. Data sources were the registers from the national mandatory notification register (Hellenic Centre for Disease Control and Prevention [HCDCP]), the National Reference Laboratory for Mycobacteria (NRLM) and SCDH records. The log-linear model with the lowest Akaike information criterion was selected as the most valid statistical model. RESULTS: The observed and estimated TB under-reporting rates at the national level were respectively 55% (95%CI 49-60) and 75% (95%CI 71-78). The observed completeness of the HCDCP, NRLM and SCDH registers were respectively 45% (95%CI 40-51), 66% (95%CI 61-71) and 36.5% (95%CI 31-42). The estimated TB incidence rate was 15 cases per 100 000 (range 13-19/100 000), compared to the 4.9/100 000 rate officially notified. CONCLUSION: Adult TB incidence has been largely underestimated, and the TB burden is likely to be much higher than officially notified in our setting. A thorough review of the notification system should be carried out. The implementation of a network-based notification system and retraining of all relevant personnel is advised.

Cross-sectional study of adult women with low back pain: Demographic and clinical profile and factors associated with disability / Estudio transversal de mujeres adultas con dolor lumbar: perfil sociodemográfico y clínico y factores asociados con la discapacidad

Objective: To identify sociodemographic, clinic profile and factors associated with low back pain (LBP) in women who consult for this reason. Methods: Cross-sectional study carried 28 October 2010 and 29 April 2011 out in 2 primary care centers in Cordoba and 1 private center in Madrid. A total of 364 women participated, with ages 20-65 years (of the 466 women contacted, 33 were excluded for inability to contact them, 29 did not attend the interview and 40 refused to participate). These women had consulted because of back pain located between the twelfth rib and the gluteal fold, with or without pain that went down the leg. They were interviewed by means of a questionnaire and the performance test was evaluated by Active Straight Leg Raise (ASLR) test. Outcome measures: Presence and intensity of LBP, Oswestry Disability Index (ODI), number of births, urinary incontinence (UI), ASLR test, digestive, respiratory and osteoarticular comorbidity, diabetes, high blood pressure, drugs, physical activity and sociodemographic data. A descriptive and multivariate statistical analysis was performed. Results: Mean age 46 years, 24% with chronic pain, 43% with UI and positive ASLR and 39% severe disability grade (ODI > 40%). In the multivariate analysis the variables associated with severe disability caused by LBP were sciatica (OR 7.439; 95% CI: 3.979-10.898), osteoarthritis (OR 3.366; 95% CI: -0.312 to 7.044), LBP intensity (OR 3.094; 95% CI: 2.303-3.885), ASLR+ (OR 2.313; 95% CI: 1.599-3.027), increased use of drugs (OR 0.811; 95% CI: 0.114-1.517) and IU (OR 0.407; 95% CI: 0.073-0.741). Conclusions: 39% of women have severe incapacity that is related to the presence of sciatica, osteoarthritis, LBP intensity, ASLR+, drugs and IU

Objetivo: Identificar las características sociodemográficas y clínicas y los factores asociados al dolor lumbar (LBP) en mujeres que consultan por este motivo. Métodos: Estudio transversal realizado en 2 centros de atención primaria de Córdoba y un centro médico privado en Madrid. Participaron 364 mujeres (de 466 contactadas, 33 fueron excluidas por imposible contacto, 29 no acudieron a la entrevista y 40 rechazaron participar) que consultaron por dolor de espalda localizado entre la duodécima costilla y el pliegue glúteo, con o sin dolor irradiado a la pierna. Se realizó entrevista con cuestionario y se valoró la ejecución del test de elevación activa de la pierna extendida (test ASLR). Medidas de resultado: Presencia e intensidad del LBP, Índice de Discapacidad de Oswestry (ODI), número de partos, incontinencia urinaria (IU), test ASLR, comorbilidad digestiva, respiratoria y osteoarticular, diabetes, hipertensión, fármacos, actividad física y datos sociodemográficos. Análisis estadístico descriptivo y multivariante. Resultados: Edad media 46 años, el 24% con dolor crónico, el 43% con IU y ASLR positivo y el 39% con una incapacidad severa (ODI > 40%). Las variables asociadas en el análisis multivariante con incapacidad severa causada por LBP son ciática (OR = 7,439; IC del 95%: 3,979-10,898), artrosis (OR = 3,366; IC del 95%: -0,312-7,044), intensidad del dolor (OR = 3,094; IC del 95%: 2,303-3,885), positividad test ASLR (OR = 2,313; IC del 95%: 1,599-3,027), mayor consumo de fármacos (OR = 0,811; IC del 95%: 0,114-1,517) e IU (OR = 0,407; IC del 95%: 0,073-0,741). Conclusiones: El 39% de las mujeres tiene una incapacidad severa que está relacionada con ciática, artrosis, intensidad del dolor, test ASLR+, fármacos e IU

Prevalence and risk factors related to intestinal parasites among children in Department of Rio San Juan, Nicaragua.

BACKGROUND: The present study was carried out to assess the prevalence of intestinal parasite infections among children in Department of Rio San Juan (Nicaragua), to explore the extent of polyparasitism, and to identify the risk factors that might favour transmission of these parasites. METHODS: A coprological study of single stool specimen, collected at random from 382 children (167 boys and 215 girls) aged 2-15 years from two municipalities, and a questionnaire, concerning demographic and epidemiological data on sanitary and behavioural habits, was filled in to identify risk factors. RESULTS: About 93% of the children presented infection. Blastocystis hominis, the most frequently protozoa, and Trichuris trichiura, Ascaris lumbricoides and hookworm, the most prevalent helminths. Polyparasitism (85.4%[326/382]), with the highest percentages detected in females (p=0.001), in the 6-11 year age group (p<0.001) and having a rural background (p<0.001). A firm relationship between any parasite and age (OR=1.2, p=0.036) and rural background (OR=0.3, p=0.027) was detected. Living in rural areas and drinking river water were also positively associated with each of the STH species detected, and walking barefoot was also associated with hookworm infection. CONCLUSIONS: Government efforts should be focused on controlling the risk factors associated with these enteroparasites, with health education programmes in rural areas of Nicaragua.

Stabilization of apoptotic cells: generation of zombie cells.

Apoptosis is characterized by degradation of cell components but plasma membrane remains intact. Apoptotic microtubule network (AMN) is organized during apoptosis forming a cortical structure beneath plasma membrane that maintains plasma membrane integrity. Apoptotic cells are also characterized by high reactive oxygen species (ROS) production that can be potentially harmful for the cell. The aim of this study was to develop a method that allows stabilizing apoptotic cells for diagnostic and therapeutic applications. By using a cocktail composed of taxol (a microtubule stabilizer), Zn(2+) (a caspase inhibitor) and coenzyme Q10 (a lipid antioxidant), we were able to stabilize H460 apoptotic cells in cell cultures for at least 72 h, preventing secondary necrosis. Stabilized apoptotic cells maintain many apoptotic cell characteristics such as the presence of apoptotic microtubules, plasma membrane integrity, low intracellular calcium levels and mitochondrial polarization. Apoptotic cell stabilization may open new avenues in apoptosis detection and therapy.

Long-term results after transcatheter aortic valve implantation: positive and side effects.

The scientific and technological progress in the field of medicine has allowed to treat patients with severe aortic valve stenosis and with a high perioperative risk. Before the introduction of transcatheter aortic valve implantation (TAVI), patients considered at high risk for surgical treatment were managed with medical therapy or with balloon aortic valvuloplasty. With more than 50000 transcatheter aortic valves implanted in patients around the world, TAVI has demonstrated to be a valid alternative to surgical aortic valve replacement in inoperable and high-risk patients. The PARTNER trial was the first randomized controlled trial to demonstrate that TAVI is not inferior to SAVR in high-risk patients. However, despite some encouraging short-term results medium and long-term outcomes are not always so encouraging. In this review, we will present the immediate results and distinct TAVI-related drawbacks and relative impact on the long-term outcome. New technology advances promise to simplify TAVI and to improve the results by reducing the rate of TAVI-specific issues such as paravalvular aortic regurgitation, annular rupture, and conduction disturbances which may impact on the clinical outcome. Therefore, we believe that when some of these weaknesses will be overcome, even patients at lower risk might benefit from TAVI in the near future.

Apoptotic microtubules delimit an active caspase free area in the cellular cortex during the execution phase of apoptosis.

Apoptotic microtubule network (AMN) is organized during apoptosis, forming a cortical structure beneath plasma membrane, which has an important role in preserving cell morphology and plasma membrane permeability. The aim of this study was to examine the role of AMN in maintaining plasma membrane integrity during the execution phase of apoptosis. We demonstrated in camptothecin-induced apoptosis in H460 cells that AMN delimits an active caspase free area beneath plasma membrane that permits the preservation of cellular cortex and transmembrane proteins. AMN depolymerization in apoptotic cells by a short exposure to colchicine allowed active caspases to reach the cellular cortex and cleave many key proteins involved in plasma membrane structural support, cell adhesion and ionic homeostasis. Cleavage of cellular cortex and plasma membrane proteins, such as α-spectrin, paxilin, focal adhesion kinase (FAK), E-cadherin and integrin subunit ß4 was associated with cell collapse and cell detachment. Otherwise, cleavage-mediated inactivation of calcium ATPase pump (PMCA-4) and Na(+)/Ca(2+) exchanger (NCX) involved in cell calcium extrusion resulted in calcium overload. Furthermore, cleavage of Na(+)/K(+) pump subunit ß was associated with altered sodium homeostasis. Cleavage of cell cortex and plasma membrane proteins in apoptotic cells after AMN depolymerization increased plasma permeability, ionic imbalance and bioenergetic collapse, leading apoptotic cells to secondary necrosis. The essential role of caspase-mediated cleavage in this process was demonstrated because the concomitant addition of colchicine that induces AMN depolymerization and the pan-caspase inhibitor z-VAD avoided the cleavage of cortical and plasma membrane proteins and prevented apoptotic cells to undergo secondary necrosis. Furthermore, the presence of AMN was also critical for proper phosphatidylserine externalization and apoptotic cell clearance by macrophages. These results indicate that AMN is essential to preserve an active caspase free area in the cellular cortex of apoptotic cells that allows plasma membrane integrity during the execution phase of apoptosis.

Procalcitonin and C-reactive protein as predictors of blood culture positivity among hospitalised children with severe pneumonia in Mozambique.

OBJECTIVES: To evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP). METHODS: 586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246). RESULTS: PCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture]. CONCLUSIONS: Among hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.

Dengue virus identification by transmission electron microscopy and molecular methods in fatal dengue hemorrhagic fever.

Dengue virus is the most significant virus transmitted by arthropods worldwide and may cause a potentially fatal systemic disease named dengue hemorrhagic fever. In this work, dengue virus serotype 4 was detected in the tissues of one fatal dengue hemorrhagic fever case using electron immunomicroscopy and molecular methods. This is the first report of dengue virus polypeptides findings by electron immunomicroscopy in human samples. In addition, not-previously-documented virus-like particles visualized in spleen, hepatic, brain, and pulmonary tissues from a dengue case are discussed.

Impact of an intensive communication strategy on end-of-life practices in the intensive care unit.

PURPOSE: Since the 2005 French law on end of life and patients' rights, it is unclear whether practices have evolved. We investigated whether an intensive communication strategy based on this law would influence practices in terms of withholding and withdrawing treatment (WWT), and outcome of patients hospitalised in intensive care (ICU). METHODS: This was a single-centre, two-period study performed before and after the 2005 law. Between these periods, an intensive strategy for communication was developed and implemented, comprising regular meetings and modalities for WWT. We examined medical records of all patients who died in the ICU or in hospital during both periods. RESULTS: In total, out of 2,478 patients admitted in period 1, 678 (27%) died in the ICU and 823/2,940 (28%) in period 2. In period 1, among patients who died in the ICU, 45% died subsequent to a decision to WWT versus 85% in period 2 (p < 0.01). Among these, median time delay between ICU admission and initiation of decision-making process was significantly different (6-7 days in period 1 vs. 3-5 days in period 2, p < 0.05). Similarly, median time from admission to actual WWT decision was significantly shorter in period 2 (11-13 days in period 1 vs. 4-6 days in period 2, p < 0.05). Finally, median time from admission to death in the ICU subsequent to a decision to WWT was 13-15 days in period 1 versus 7-8 days in period 2, p < 0.05. Reasons for WWT were not significantly different between periods. CONCLUSION: Intensive communication brings about quicker end-of-life decision-making in the ICU. The new law has the advantage of providing a legal framework.

Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices.

PURPOSE: Burnout syndrome (BOS) has frequently been reported in healthcare workers, and precipitating factors include communication problems in the workplace and stress related to end-of-life situations. We evaluated the effect of an intensive communication strategy on BOS among caregivers working in intensive care (ICU). METHODS: Longitudinal, monocentric, before-and-after, interventional study. BOS was evaluated using the Maslach Burnout Inventory (MBI) and depression using the Centre for Epidemiologic Studies Depression Scale (CES-D) in 2007 (period 1) and 2009 (period 2). Between periods, an intensive communication strategy on end-of-life practices was implemented, based on improved organisation, better communication, and regular staff meetings. RESULTS: Among 62 caregivers in the ICU, 53 (85%) responded to both questionnaires in period 1 and 49 (79%) in period 2. We observed a significant difference between periods in all three components of the MBI (emotional exhaustion, p = 0.04; depersonalization p = 0.04; personal accomplishment, p = 0.01). MBI classified burnout as severe in 15 (28%) caregivers in period 1 versus 7 (14%) in period 2, p < 0.01, corresponding to a 50% risk reduction. Symptoms of depression as evaluated by the CES-D were present in 9 (17%) caregivers in period 1 versus 3 (6%) in period 2, p < 0.05, corresponding to a risk reduction of almost 60%. CONCLUSION: The implementation of an active, intensive communication strategy regarding end-of-life care in the ICU was associated with a significant reduction in the rate of burnout syndrome and depression in a stable population of caregiving staff.

Prevalence and molecular characterization of Cryptosporidium in schoolchildren from department of Rio San Juan (Nicaragua).

A cross-sectional study of cryptosporidiosis was carried out in Nicaragua. The prevalence of Cryptosporidium infection was determined in 272 (110 boys and 162 girls) schoolchildren, aged between 4 to 15 years from department of Rio San Juan. The total percentage obtained for Cryptosporidium (35.7%) was one of the highest reported so far. Cryptosporidium appeared in 94.8% of multiparasitism cases. No significant statistical differences were detected in the cryptosporidiosis prevalence between loose/watery (22.2%) and soft/formed (36.7%) stool samples. No significant age and sex differences were observed. This is the first report to identify Cryptosporidium in Nicaragua at species level, providing a preliminary molecular characterization of all positive samples, such as Cryptosporidium parvum (genotype 2). The high prevalence of C. parvum suggests that animals may be potential sources of infection for human cryptosporidiosis, although C. parvum infections may have originated from humans themselves. The human health problem caused by Cryptosporidium in this region may be related to the poor human hygiene/sanitation and contamination of the environment, food, or water supplies. Continuous exposure to the parasite could have been protective against development of symptoms in the children examined.

Immunolocalization of NK-1 receptor and Substance P in human normal placenta.

A role for Substance P (SP) in human placenta is not known, although is possible that regulates placental physiology through the Neurokinin (NK)-1 receptor. Ten human normal placenta tissues were studied by immunohistochemistry to demonstrate the localization of NK-1 receptor and SP. An immunostaining pattern for NK-1 receptor and SP was observed in the endothelium and myocytes of fetal blood vessels, decidua and trophoblast. The SP is located in both the cytoplasm and the nucleus whereas NK-1 receptor in cytoplasmic. These findings reported here for the fist time, suggest a role for the SP and NK-1 receptor in the placental physiology.

Esofaguectomía en un paciente con trasplante hepático ortotópico / Esophagectomy

No disponible

No disponible

Características de las heparinas de bajo peso molecular (HBPM) / Low-Molecular-Weight Heparins (LMWH)

Las heparinas de bajo peso molecular (HBPM) se obtienen a partir de la heparina no fraccionada (HNF) por diversos procedimientos, obteniéndose unos productos con un peso molecular entre los 3.000 y los 9.000 daltons. La heparina tiene una acción anticoagulante que ejerce mediante la formación de un compuesto ternario, uniéndose a la antitrombina y a la trombina (IIa), para lo que se necesitan 18 sacáridos. La otra acción antitrombótica sólo necesita 5 sacáridos para unirse a la antitrombina e inhibir el factor X activado. Como las HBPM tienen una gran proporción de cadenas de menos de 18 sacáridos, poseen una mayor capacidad antitrombótica (anti-Xa) que anticoagulante (anti-IIa). Además tienen una menor afinidad por las proteínas plasmáticas, por las células endoteliales y por los macrófagos que la HNF. Tienen una mayor biodisponibilidad y una eliminación más lenta, por lo que la vida media es más prolongada que en la HNF. Las HBPM tienen una respuesta antitrombótica predecible y no necesitan control de laboratorio, salvo en caso de insuficiencia renal importante, obesidad mórbida o embarazo. En estos casos hay que medir la actividad anti-Xa. Existen menos complicaciones hemorrágicas y trombopenia que con la HNF. Las HBPM disponibles en España son bemiparina, dalteparina, enoxaparina, nadroparina y tinzaparina cuyas características se revisan y se insiste en que son fármacos distintos y no intercambiables. Características de las heparinas de bajo peso molecular (HBPM) (AU)