Factores clínico-radiológicos asociados con muerte encefálica precoz / Clinico-radiological related to early brain death factors

Objective: To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h. Design A retrospective cohort study was made covering the period 2015−2017. Setting An adult Intensive Care Unit (ICU).Patients/methodsEpidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. Results A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups.ConclusionsEarly BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation (AU)

Objetivo: Identificar los factores clínico-radiológicos que se asocian a evolución precoz a muerte encefálica (ME), definida esta como la ocurrida en ≤24 horas Diseño Estudio de cohortes retrospectivo desde 2015 hasta 2017, ambos incluidos. Ámbito Servicio de Medicina Intensiva (SMI) de adultos.Pacientes y métodoAnálisis de variables clínico-epidemiológicas y de la TC craneal de ingreso en pacientes con evolución a ME. Resultados Se analizaron 166 ME, 86 varones, edad media 62,7 años, 42,8% hemorragia intracerebral, 18,7% HSA, 17,5% TCE, 7,8% ictus isquémico, 9% anoxia y 4,2% otras causas; 50% HTA, 34% dislipemia, 33% tabaquismo, 21% antiagregación, 19% enolismo. El 15% anticoagulación, 15% diabetes. El GCS fue tres en el 68,8% en ME precoz frente 38,2% en ME >24 h (p 0,0001); 85 hematoma supratentorial (90,9 mL en ME precoz vs. 82,7 mL ME tardía, p 0,54); 12 hematoma infratentorial. Desplazamiento medio de línea media 10,7 mm en ME precoz vs. 7,8 mm en ME tardía (p 0,045); 91 pacientes ventriculomegalia y 38 trasudado periependimario (p 0,021). Borramiento completo de cisternas basales 36 en ME precoz frente a 24 en ME tardía (p 0,005), borramiento de surcos (p 0,013), pérdida de diferenciación córtico-subcortical (p 0,0001) y ausencia de cisterna supraselar (p 0,005). La medición de la vaina del nervio óptico no mostró diferencias significativas entre los dos grupos.ConclusionesSe asoció con ME ≤ 24 horas el GCS < 5, el desplazamiento de línea media, la pérdida de diferenciación córtico-subcortical, el borramiento de surcos, el borramiento completo de cisternas basales, de la cisterna supraselar y la presencia de trasudado periependimario (AU)

Clinico-radiological related to early brain death factors.

OBJECTIVE: To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h. DESIGN: A retrospective cohort study was made covering the period 2015-2017. SETTING: An adult Intensive Care Unit (ICU). PATIENTS/METHODS: Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS: A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS: Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.

Clinico-radiological related to early brain death factors. / Factores clínico-radiológicos asociados con muerte encefálica precoz.

OBJECTIVE: To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 hours. DESIGN: A retrospective cohort study was made covering the period 2015-2017. SETTING: An adult Intensive Care Unit (ICU). PATIENTS/METHODS: Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS: A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD >24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD >24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD >24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS: Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.

Specific leaf mass, fresh: dry weight ratio, sugar and protein contnts in species of Lamiaceae from different light enviroments

Samples from eleven species of Lamiaceae were collected from different light environments in Venezuela for laboratory analysis.The studied species were: Plectranthus scutellarioides (Ps), Scutellaria purpurascens (Sp), Hyptis pectinata (Hp), H. sinuata (Hs), Leonorus japonicus (Lj), Plecthranthus amboinicus (Pa) Ocimum basilicum (Ocb), O.campechianum (Occ) Origanum majorana (Orm), Rosmarinus officinali ,(Ro) and Salvia officinalis (So). Protein and soluble sugar contents per unit of area were measured, Specific Leaf Mass (SLM)and fresh: dry weight (FW/DW) ratios were calculated. The higher values for soluble sugars contents were present in sun species: Lj, Pa, Ocb, Occ, Or. m, Ro and So; the lower values were obtained in low light species: Ps, Sp, Hp, Hs. The values of protein content do not show any clear trend or difference between sun and shade environments. The lowest values for the fresh weight: dry weight ratio are observed in sun species with the exception of Lj and Pa, while the highest value is observed in Pa, a succulent plant. The higher values of specific leaf mass (SLM)(Kg DMm-2) are observed in sun plants. The two way ANOVA revealed that there were significant differences among species and between sun and low light environments for sugar content and FW: DW ratio, while SLM was significant for environments but no significant for species, and not significant for protein for both species and environments. The soluble sugar content, FW: DW ratio and SLM values obtained in this work, show a clear separation between sun and shade plants. The sugar content and FW:DW ratio are distinctive within the species,and the light environment affected sugar content, FW:DW ratio and SLM. These species may be shade-tolerant and able to survive in sunny environments. Perhaps these species originated in shaded environments and have been adapting to sunny habitats

En once especies de la familia Lamiaceae: Plecthranthus scutellarioides R. Br. (Ps); S cutellaria purpurascens Sw.(Sp); Hyptis pectinata (L.) Poit.(Hp); Hyptis sinuata Kunth (Hs); Ocimum basilicum L.(Ocb); Ocimum campechianum Miller.(Occ); Origanum majorana L.(Orm); Rosmarinus officinalis L.(Ro); Salvia officinalis L.(So) and Plecthranthus amboinicus (Lour) Spreng.(Pa) and Leonorus japonicus Hout., (Lj), provenientes de diferentes ambientes de exposición a la luz solar, fueron medidos los contenidos de proteínas y azúcares, expresados por unidad de área y fueron calculados la masa específica foliar (MEF)y la relación peso fresco: peso seco (PF:PS). Los mayores valores en el contenido de azúcar fueron observados en plantas que crecieron a exposición directa de luz solar: Lj, Pa, Ocb, Occ, Or. m, Ro and So; mientras que los menores valores se presentaron en aquellas plantas provenientes de ambientes más frecuentemente sombreados e interrumpidos por rayos de sol: Ps, Sp, Hp, Hs. Los valores en el contenido de proteínas no muestran diferencias. Los menores valores de PF:DW fueron observados en las plantas expuestas a radiación solar directa, con la excepción de L. japonicus y P. amboinicus ,esta última es suculenta. Los mayores valores de MEF se presentaron en plantas de sol. El análisis de varianza de dos vías reveló que había diferencias significativas entre especies y ambientes para el contenido de azúcares y la relación PF: PS, mientras que para MEF, la diferencia fue significativa solo entre ambientes; en el caso del contenido de proteínas las diferencias no fueron significativas para especies y ambientes. El contenido de azúcares, la relación PF: PS y la MEF muestran una clara separación entre las especies de sol y las de sombra. Parece que en las especies de Lamiaceae estudiadas, el contenido de azúcares, y la relación PF: PS son distintivos entre las especies mismas y la radiación solar afecta el contenido de azúcares, la relación PF: PS y la MEF. Podría suponerse que estas especies sean tolerantes a la sombra y capaces a su vez, de vivir en ambientes soleados, más aún, de acuerdo a estos resultados y a otros relativos a estas mismas especies, pudiera interpretarse que tienen su origen en ambientes sombreados y que han ido ocupando y adaptándose a ambientes soleados, basándose en la plasticidad fisiológica inducida por las variaciones ambientales de luz

Specific leaf mass, fresh: dry weight ratio, sugar and protein contents in species of Lamiaceae from different light environments.

Samples from eleven species of Lamiaceae were collected from different light environments in Venezuela for laboratory analysis. The studied species were: Plectranthus scutellarioides (Ps), Scutellaria purpurascens (Sp), Hyptis pectinata (Hp)), H. sinuata (Hs). Leonorus japonicus (Lj), Plecthranthus amboinicus (Pa) Ocimum hasilicum (Ocb), O. campechianum (Occ) Origanum majorana (Orm), Rosmarinus officinali, (Ro) and Salvia officinalis (So). Protein and soluble sugar contents per unit of area were measured, Specific Leaf Mass (SLM) and fresh:dry weight (FW/DW) ratios were calculated. The higher values for soluble sugars contents were present in sun species: Lj, Pa, Ocb, Occ, Orm, Ro and So; the lower values were obtained in low light species: Ps, Sp, Hp, Hs. The values of protein content do not show any clear trend or difference between sun and shade environments. The lowest values for the fresh weight: dry weight ratio are observed in sun species with the exception of Lj and Pa, while the highest value is observed in Pa, a succulent plant. The higher values of specific leaf mass (SLM) (Kg DMm(-2)) are observed in sun plants. The two way ANOVA revealed that there were significant differences among species and between sun and low light environments for sugar content and FW:DW ratio. while SLM was significant for environments but no significant for species, and not significant for protein for both species and environments. The soluble sugar content, FW:DW ratio and SLM values obtained in this work, show a clear separation between sun and shade plants. The sugar content and FW:DW ratio are distinctive within the species, and the light environment affected sugar content. FW:DW ratio and SLM. These species may he shade-tolerant and able to survive in sunny environments. Perhaps these species originated in shaded environments and have been adapting to sunny habitats.

[Evaluation of medical reports received from the second level of care]. / Valoración de los informes médicos recibidos del segundo nivel.

OBJECTIVES: To quantify the monthly inter-clinic rate (MIR), the medical reports received, their quality and the period of delay until the first second-level consultation. DESIGN: Cross-sectional, descriptive study. SETTING: Rural health centre. SAMPLE: 498 first consultations requested of the second level by three family medicine lists between June and November 1999. 132 were excluded for presenting a criterion of exclusion (consultations within the second level, check-ups, appointments missed by the patient and consultations that could not be recorded), which left a sample size of 366. MEASUREMENTS AND RESULTS: Mean MIR was 34 . Ophthalmology (21.9%), gynaecology (15.3%) and traumatology (13.9%) were the most commonly requested services. 69 reports (18.8%) were received, leaving 297 (81.2%) not received. Pneumology (100%) and internal medicine (81.8%) services sent through most reports, whereas haematology and rehabilitation (0%) sent through least. The mean score on the reports was 8 +/- 2 out of a maximum of 10. Mean delay was 73 +/- 46 days. CONCLUSION: The monthly inter-clinic rate found was within the figures cited in the literature. The percentage of reports received was way below what was found in the literature, but their quality was good.

Valoración de los informes médicos recibidos del segundo nivel / Evaluation of the medical reports received from the second care level

Objetivos. Cuantificar la tasa de interconsulta mensual (TIM), porcentaje de informes médicos recibidos, calidad de éstos y tiempo de demora de la primera consulta al segundo nivel. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud rural. Muestra. Las 498 primeras consultas solicitadas al segundo nivel de 3 cupos de médicos de familia desde junio a noviembre de 1999. Se excluyeron 132 por presentar algún criterio de exclusión (consultas entre el segundo nivel, revisiones, consultas a las que el paciente no acudió y aquellas que no se pudieron registrar), quedando un tamaño muestral de 366 (n).Mediciones y resultados. La TIM media fue del 34 . Los servicios de oftalmología (21,9 por ciento), ginecología (15,3 por ciento) y traumatología (13,9 por ciento) fueron los más solicitados. Se recibieron 69 informes (18,8 por ciento), quedando 297 (81,2 por ciento) sin recibir. Los servicios de neumología (100 por ciento) y medicina interna (81,8 por ciento) fueron los que más informes remitieron, mientras que hematología y rehabilitación (0 por ciento) fueron los que menos. La puntuación media de los informes fue de 8 ñ 2 sobre un máximo de 10. La demora media fue de 73 ñ 46 días. Conclusión. La TIM se encuentra entre los valores descritos en la bibliografía. El porcentaje de informes recibidos es muy inferior a lo hallado en la bibliografía, pero su calidad es buena (AU)