Perfil del paciente que sufre caídas en el entorno hospitalario: estudio multicéntrico / Profile of the patient who suffers falls in the hospital environment: Multicenter study

OBJETIVOS: Analizar el perfil de los pacientes que sufren caídas en el entorno hospitalario. MÉTODO: Estudio longitudinal, de seguimiento prospectivo de una cohorte de pacientes reclutada de mayo de 2014 a marzo de 2016. Participaron 5 hospitales de agudos de la Comunidad de Andalucía de unidades médicas, quirúrgicas y cuidados intensivos. Se incluyeron pacientes mayores de 16 años. Las variables de caracterización fueron: edad, sexo, unidad, estancia, medidas preventivas; y las de resultado: nivel de conciencia, déficits sensoriales, movilidad, número de caídas, circunstancias y consecuencias, medicamentos, caídas previas. RESULTADOS: Se reclutaron 1.247 pacientes, de los que 977 completaron el estudio. La incidencia de caídas fue del 2,35%. La edad media de las personas que sufrieron caídas fue de 73,6 años (p = 0,015). El evento aconteció sobre todo en las mujeres (56,5%) y en las unidades médicas (79%). Las caídas ocasionaron daños menores. La reordenación del mobiliario demostró ser la única medida protectora (OR=3,95; IC95% 1,46-10,68; p = 0,015). Los factores predictivos del suceso fueron: haber ingresado en el hospital tras una caída (HR=5,88; IC95% 3,23-10,67; p < 0,001), seguido de problemas visuales, ir al baño con frecuencia y haber sufrido caídas previas. CONCLUSIONES: El perfil del paciente que sufre caídas en el hospital se presenta como mayor de 70 años, mujer, ingresada en una unidad médica, durante el turno de noche, estando en cama y solo, sin deterioro del nivel de conciencia y con antecedentes de caídas

AIMS: To analyse the profile of patients suffering from falls in the hospital environment. METHOD: Longitudinal study, prospective follow-up of a cohort of patients recruited from May 2014 to March 2016. Medical, surgical and intensive care units of 5 acute hospitals of the Community of Andalusia participated. Patients older than 16 years were included. The variables of characterization were: age, sex, unit, stay, preventive measures, and those of result: level of consciousness, sensory deficits, mobility, number of falls, circumstances and consequences, medications, previous falls. RESULTS: 1,247 patients were recruited, of whom 977 completed the study. The incidence of falls was 2.35%. The average age of the faller was 73.6 years (P=.015). The event occurred mostly in women (56.5%) and in medical units (79%). The falls caused minor damage. Rearrangement of the furniture proved to be the only protective measure (OR= 3.95, 95% CI 1.46-10.68, P=.015). The predictors of the event were: having been admitted to the hospital after a fall (HR= 5.88, 95% CI 3.23-10.67, P<.001), followed by visual problems, frequent visits to the bathroom and having suffered previous falls. CONCLUSIONS: The profile of the patient suffering falls in the hospital is presented as aged over 70 years old, female, admitted to a medical unit, during the night shift, being in bed and alone, without impaired level of consciousness and with a history of falls

Profile of the patient who suffers falls in the hospital environment: Multicenter study. / Perfil del paciente que sufre caídas en el entorno hospitalario: estudio multicéntrico.

AIMS: To analyse the profile of patients suffering from falls in the hospital environment. METHOD: Longitudinal study, prospective follow-up of a cohort of patients recruited from May 2014 to March 2016. Medical, surgical and intensive care units of 5 acute hospitals of the Community of Andalusia participated. Patients older than 16 years were included. The variables of characterization were: age, sex, unit, stay, preventive measures, and those of result: level of consciousness, sensory deficits, mobility, number of falls, circumstances and consequences, medications, previous falls. RESULTS: 1,247 patients were recruited, of whom 977 completed the study. The incidence of falls was 2.35%. The average age of the faller was 73.6 years (P=.015). The event occurred mostly in women (56.5%) and in medical units (79%). The falls caused minor damage. Rearrangement of the furniture proved to be the only protective measure (OR= 3.95, 95% CI 1.46-10.68, P=.015). The predictors of the event were: having been admitted to the hospital after a fall (HR= 5.88, 95% CI 3.23-10.67, P<.001), followed by visual problems, frequent visits to the bathroom and having suffered previous falls. CONCLUSIONS: The profile of the patient suffering falls in the hospital is presented as aged over 70 years old, female, admitted to a medical unit, during the night shift, being in bed and alone, without impaired level of consciousness and with a history of falls.

Adaptación transcultural del instrumento «STRATIFY» para la valoración del riesgo de caídas / Cross-cultural adaptation of the STRATIFY tool in detecting and predicting risk of falling

OBJETIVOS: Adaptar al castellano la escala STRATIFY para su uso clínico en el contexto español. MÉTODO: Se realizó un estudio transversal, multicéntrico, en 2 ámbitos asistenciales: hospitales de agudos y residencias geriátricas, de adaptación transcultural realizado en la Comunidad Autónoma de Andalucía durante el año 2014. El proceso de adaptación se estructuró en 4 etapas: traducción, retrotraducción, equivalencia entre las 2 retrotraducciones y pilotaje, obteniendo la versión definitiva en español. Se tuvieron en cuenta la validez de aspecto, la validez de contenido y el tiempo necesario en cumplimentar la escala. La validez de contenido se obtuvo a través del cálculo del índice global de validez de contenido. Para su análisis se calculó la mediana, la tendencia central y dispersión de las puntuaciones. RESULTADOS: El índice global de validez de contenido obtuvo un resultado positivo de 1. Para la validez de aspecto se tuvieron en cuenta la claridad y comprensión de las preguntas. De las 5 preguntas del instrumento, 2 presentaron una pequeña discordancia solventada con la introducción de una frase aclaratoria para conseguir una equivalencia conceptual. Las medianas de ambas preguntas fueron iguales o superiores a 5. El tiempo medio de cumplimentación de la escala fue inferior a los 3min. CONCLUSIONES: El proceso de adaptación al castellano de STRATIFY ha permitido obtener una versión semántica y culturalmente equivalente a la original de fácil cumplimentación y comprensión para su uso en el contexto español

AIMS: To adapt to Spanish language the STRATIFY tool for clinical use in the Spanish-speaking World. METHOD: A multicenter, 2 care settings cross-sectional study cultural adaptation study in acute care hospitals and nursing homes was performed in Andalusia during 2014. The adaptation process was divided into 4 stages: translation, back-translation, equivalence between the 2 back-translations and piloting of the Spanish version, thus obtaining the final version. The validity of appearance, content validity and the time required to complete the scale were taken into account. For analysis, the median, central tendency and dispersion of scores, the interquartile range, and the interquartile deviation for the possible variability in responses it was calculated. RESULTS: Content validity measured by content validity index reached a profit of 1. For the validity aspect the clarity and comprehensibility of the questions were taken into account. Of the 5 questions of the instrument, 2 had a small disagreement solved with the introduction of an explanatory phrase to achieve conceptual equivalence. Median both questions were equal or superior to 5. The average time for completion of the scale was less than 3 minutes. CONCLUSIONS: The process of adaptation to Spanish of STRATIFY has led to a semantic version and culturally equivalent to the original for easy filling and understanding for use in the Spanish-speaking world

Cross-cultural adaptation of the STRATIFY tool in detecting and predicting risk of falling. / Adaptación transcultural del instrumento «STRATIFY¼ para la valoración del riesgo de caídas.

AIMS: To adapt to Spanish language the STRATIFY tool for clinical use in the Spanish-speaking World. METHOD: A multicenter, 2 care settings cross-sectional study cultural adaptation study in acute care hospitals and nursing homes was performed in Andalusia during 2014. The adaptation process was divided into 4 stages: translation, back-translation, equivalence between the 2 back-translations and piloting of the Spanish version, thus obtaining the final version. The validity of appearance, content validity and the time required to complete the scale were taken into account. For analysis, the median, central tendency and dispersion of scores, the interquartile range, and the interquartile deviation for the possible variability in responses it was calculated. RESULTS: Content validity measured by content validity index reached a profit of 1. For the validity aspect the clarity and comprehensibility of the questions were taken into account. Of the 5 questions of the instrument, 2 had a small disagreement solved with the introduction of an explanatory phrase to achieve conceptual equivalence. Median both questions were equal or superior to 5. The average time for completion of the scale was less than 3 minutes. CONCLUSION: The process of adaptation to Spanish of STRATIFY has led to a semantic version and culturally equivalent to the original for easy filling and understanding for use in the Spanish-speaking world.

Molusco contagioso: ¿cuándo debería iniciarse el tratamiento? / Molluscum contagiosum: when should treatment start?

El molusco contagioso es una enfermedad vírica común en la infancia, que se presenta como pápulas umbilicadas firmes y pequeñas. Dado que se considera una enfermedad autolimitada, hay un debate continuo sobre si las lesiones asociadas se deben tratar o esperar a que se resuelvan espontáneamente. Sin embargo, las lesiones tardan entre 6 y 48 meses en curarse, y generan una gran preocupación tanto en los niños (a menudo limitan su asistencia al colegio y su actividad social) como en los cuidadores. El tratamiento puede acortar el curso de la enfermedad, posiblemente reduce la autoinoculación y la transmisión, e incrementa la calidad de vida del paciente (AU)

Molluscum contagiosum is a common viral disease of childhood which presents itself as small, firm, umbilicated papules. Since it is considered a self-limiting disease, debate continues about whether lesions associated with this disease should be treated or allowed to resolve spontaneously. However, the lesions take between 6 and 48 months to resolve and are a source of great embarrassment for both carers and children, often affecting the children’s attendance at school and limiting their social activity. Treatment can shorten the disease course, possibly reducing autoinoculation and transmission, and increases the patients’ quality of life (AU)

Cambios histopatológicos en arterias humanas sometidas a procesos de isquemia fría y criopreservación / Histopathological changes in human arteries following cold ischemia and cryo preservation processes

Introducción. La creciente demanda de injertos vasculares ha provocado una búsqueda continua del método `ideal' para minimizar los daños vasculares durante el proceso de conservación. Objetivo. Estudiar la repercusión sobre la histología arterial del proceso de preservación del tejido en sus distintas fases. Pacientes y métodos. Hemos analizado 86 segmentos arteriales (ilíaca y femoral superficial) procedentes de 50 donantes. De cada segmento se obtuvieron tres muestras en distintas fases del proceso, y se establecieron otros tantos grupos de estudio: arterias frescas; postisquemia fría y poscriopreservación. El tiempo máximo de isquemia fria fue de 20 horas y las muestras se mantuvieron en solución antibiótica a 4 °C. La criopreservación se realizó en una solución con dimetil sufóxido (DMSO) con descenso térmico programado de 1 ºC / min con almacenamiento en fase gas (-150 °C a -190 °C). Se valoraron parámetros como la preservación del endotelio, la intensidad de cambios degenerativos (degeneración mixoide, apoptosis) en la pared arterial y la presencia de fracturas, comparando los resultados entre los distintos grupos. Se estudiaron igualmente las causas que llevaron al fracaso de algunos injertos. Resultados. El 81,4 por ciento de las arterias criopreservadas mostró una pérdida prácticamente total del endotelio (3,5 por ciento en los otros dos grupos) y más del 50 por ciento, importantes cambios degenerativos en su pared frente al 3,5 y 8,1 por ciento de los grupos 1 y 2. Conclusiones. El proceso de criopreservación provoca una importante pérdida endotelial y cambios degenerativos en la pared arterial. El tiempo de isquemia fría que se empleó en nuestro estudio no tiene repercusión en la estructura arterial (AU)

Application of programmed-temperature split/splitless injection to the trace analysis of aliphatic hydrocarbons by gas chromatography.

The dependence of the programmed-temperature solvent split sampling technique using a PSS (programmed-split/splitless) injection mode on different variables affecting the introduction of large sample volumes for a mixture of alkanes in capillary GC was evaluated. Apart from the studies found in the literature on different factors such as speed of injection. presence of adsorbent in the liner, internal diameter of the liner, initial and final injector temperature, split flow-rate and initial split time, affecting the chromatographic signal of different compounds, others were studied whose influence has not been considered until now. They include length of the microsyringe needle, adsorbent distribution in the liner, injection volume on analyte discrimination, speed of injector heating, time which the column stays at the initial temperature and time that the injector stays at the final temperature. Once finalised, the study of the PSS injection mode was compared with the conventional mode of gas chromatography splitless injection, and found that the proposed method increases sensitivity in GC trace analysis. Finally, the application of both injection modes in the determination of aliphatic hydrocarbons was tested in an atmospheric particulate sample.

Dimensions of the left ventricle, atrium, and aortic root in pregnancy-induced hypertension.

Chronic hypertension induces changes in the structure of the left ventricle, atrium, and aortic root. However, the effects of transient hypertension are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. Using M-mode echocardiography, we studied 95 consecutive patients with PIH, who were compared with 83 normal pregnant women (NPW). We evaluated diastolic diameter (DD), systolic diameter (SD), septal thickness (ST), posterior wall thickness (PWT), shortening fraction (SF), relative wall thickness (RWT), left ventricular mass index (LVMI), left atrial dimension (LAD), and aortic root dimension (ARD). Patients with PIH had higher ST (9.98 +/- 1.47 mm v 8.96 +/- 1.43 mm, P < .000), PWT (9.28 +/- 1.48 mm v 8.55 +/- 1.35 mm, P < .000), LVMI (107.65 +/- 27.87 g/m2 v 92.38 +/- 17.99 g/m2, P < .000), and RWT (0.406 +/- 0.06 v 0.377 +/- 0.06 mm, P < .002). There were no significant differences in DD, SD, SF, LAD, and ARD. In conclusion, PIH increases the LVMI due to an increase in the ST and PWT. The dimensions of the left ventricle, left atrium, and aortic root do not change.

Left ventricular function impairment in pregnancy-induced hypertension.

The changes induced by transient hypertension on cardiac structure and function are unclear. Pregnancy-induced hypertension offers a natural and spontaneous model of this condition. To assess the potential of echocardiographic Doppler to unmask left ventricular function impairment, we studied 28 women aged 26.4 +/- 7.2 years with pregnancy-induced hypertension defined as blood pressure higher than 140/90 mm Hg in the third trimester of pregnancy without a history of hypertension. Twenty normal pregnant women, aged 27.5 +/- 6.4 years, were the controls. Left ventricular diastolic diameter, fractional shortening, E velocity, A velocity, E/A ratio, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET), and the combined index of myocardial performance (Tei index = IRT + ICT/ET), were calculated by echocardiography Doppler 2 to 4 days postpartum. There were statistically significant differences between groups in the following parameters: E/A ratio: 1.3 +/- 0.3 in pregnancy-induced hypertension v 1.5 +/- 0.3 in normal pregnant women (P < .05), IRT: 104 +/- 14 msec v 84 +/- 7 msec (P < .000), and the Tei index: 0.51 +/- 0.15 v 0.35 +/- 0.04 (P < .00), respectively. According to this data pregnancy-induced hypertension evaluated 2 to 4 days after delivery showed left ventricular dysfunction, mainly diastolic. The IRT and the Tei index are the most useful echocardiographic parameters to unmask left ventricular dysfunction in pregnancy-induced hypertension.

Efficacy of amiodarone for the termination of chronic atrial fibrillation and maintenance of normal sinus rhythm: a prospective, multicenter, randomized, controlled, double blind trial.

OBJECTIVE: We sought to assess the efficacy and safety of amiodarone for restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation in a prospective, randomized, double blind trial. BACKGROUND: Restoration and preservation of sinus rhythm is difficult in patients with chronic atrial fibrillation. The efficacy of oral amiodarone has not been conclusively established. METHODS: Ninety-five patients with chronic atrial fibrillation, lasting an average of 35.6 months, were randomized to either amiodarone (600 mg/d) (47 patients) or placebo (48 patients) during four weeks. Nonresponders underwent electric cardioversion, and those who reverted continued with amiodarone (200 mg/d) or placebo. End-points were successful cardioversion and sinus rhythm maintenance. RESULTS: Sixteen patients (34.04%) in the amiodarone group reverted within 27.28 +/- 8.85 days in comparison with 0% in the placebo group (P < 0.000009). The conversion rate rose to 51.72% in patients with chronic atrial fibrillation lasting less than 12 months. Twenty-eight patients in the amiodarone group and 39 in the placebo group underwent electric cardioversion, which was successful in 19 patients (67.8%) of the amiodarone group and in 15 (38.46%) of the placebo group (P = 0.017). Altogether, conversion was obtained in 79.54% of the amiodarone group patients and in 38.46% of the placebo group patients (P < 0.0001). During follow-up, atrial fibrillation relapsed in 13 (37.14%) of 35 patients of the amiodarone group within 8.84 +/- 8.57 months and in 12 (80%; P = 0.009) of 15 patients of the placebo group within 2.74 +/- 3.41 months. CONCLUSIONS: Oral amiodarone restored sinus rhythm in one third of patients with chronic atrial fibrillation, increased the success rate of electric cardioversion, decreased the number of relapses and delayed their occurrence.

Left ventricular geometry in pregnancy-induced hypertension.

The changes induced by transient hypertension upon cardiac geometry (G) are unclear. Pregnancy-induced hypertension (PIH) offers a natural and spontaneous model of this condition. To assess geometric changes according to two-dimensionally guided M-mode echocardiography, we compared patients with PIH with normal pregnant women (NPW). Fifty-five women, aged 28.5 +/- 7.5 years, with PIH (defined as blood pressure >140/90 mm Hg in the third trimester of pregnancy and without a history of hypertension) were compared with 57 NPW aged 30.7 +/- 7.5 years. Left ventricular mass index (LVMI) (Devereux formula) and relative wall thickness (RWT) (Ganau formula) were calculated by means of echocardiography done in the left lateral decubitus 2 to 4 days postpartum. Subjects were considered to have: normal geometry (NG) if both LVMI and RWT fell below the mean +/- 1 SD or 2 SD; concentric hypertrophy (CH) if both were elevated; eccentric hypertrophy (EH) if LVMI was elevated and RWT was normal; and concentric remodeling (CR) if LVMI was normal and RWT was elevated. Comparisons were performed by the Student t test. Patients with PIH had higher LVMI (106 +/- 29.4 v 90.6 +/- 19.8 g/m2; P < .05) and RWT (0.41 +/- 0.07 v 0.38 +/- 0.05; P < .05). Considering the mean +/- 1 SD of NPW as the limit of normality the G pattern was NG in 26 (47%) and abnormal in 29 (53%), of which 14 (25.5%) had EH, 11 (20%) had CR, and four (7%) had CH. If we considered the mean +/- 2 SD, the G pattern was NG in 46 (84%) and abnormal G in nine (16%), EH in four (7%), CR in three (5%), and CH in 2 (4%). According to these data, women with PIH had higher LVMI and RWT compared with NPW. The most frequent abnormal G patterns were EH and CR.

Isolated tricuspid valve disease in antiphospholipid syndrome.

Cardiac valve involvement in antiphospholipid syndrome (APS) has been consistently shown. However, isolated tricuspid valve disease within this syndrome has only been recently reported. We report a patient with primary antiphospholipid syndrome who had isolated tricuspid organic valve disease, pulmonary hypertension and pulmonary thromboembolism. We suggest that the APS should be listed as one of the aetiologies of organic isolated tricuspid valve disease in the adult population.

Simultaneous determination of organic acids and vitamin C in green beans by liquid chromatography.

A method is described for determining and quantitating organic acids (oxalic, malic, citric, and fumaric) and vitamin C by liquid chromatography with a UV-visible detector that allows simultaneous monitoring at 2 wavelengths. The method was applied to samples of green beans (Phaseolus vulgaris L.). Recoveries were 97.8% for oxalic acid, 98.9% for malic acid, 98.7% for citric acid, 99.2% for fumaric acid, and 98.5% for vitamin C. Method precisions (coefficients of variation) were 1.7% for oxalic acid, 0.8% for malic acid, 0.9% for citric acid, 1.5% for fumaric acid, and 1.2% for vitamin C. Measurement precisions (coefficients of variation) were 1.32% for oxalic acid, 0.33% for malic acid, 0.62% for citric acid, 1.01% for fumaric acid, and 0.39% for vitamin C. Limits of detection were 0.025 mg/mL for oxalic acid, 0.022 mg/mL for malic acid, 0.024 mg/mL for citric acid, 1.0 x 10(-4) mg/mL for fumaric acid, and 2.7 x 10(-4) mg/mL for vitamin C.

Symptoms and arrhythmias during 24 hour ambulatory electrocardiographic monitoring

Se evaluó la correlación entre síntomas y arrtmias que se presentaron durante un monitoreo electrocardiográfico de 24h en 1558 pacientes (790 varones y 768 mujeres) de 13 a 86 años de edad (media: 56,7 años). Se registraron arritmias ventriculares en 56,9% de los pacientes (886/1558) y arritmias supraventriculares en 26,6% (414/1558). Durante el período de registro sólo 32,5% de los pacientes (507/1558 refirieron síntomas sugestivos de alteraciones del ritmo. La diferencia en la incidencia de síntomas en los pacientes sin arritmias y con arritmias menores o arritmias mayores no fue estadísticamente significativa. Sólo el 16,6% de los pacientes sintomáticos (84/507) presentaron síntomas simultáneos con las arritmias y, en este grupo, los pacientes con arritmias supraventriculares y ventriculares menores presentaron una menor incidencia de síntomas que aquellos con arritmias supraventriculares o ventriculares mayores (p<0,001 y p<0,005, respectivamente). De ellos, 188 pacientes tuvieron síntomas asociados con registros normales que resultaron útiles para excluir arritmias como causa. Las mujeres presentaron más síntomas que los varones tuvieran o no arritmias (p<0,001)

Symptoms and arrhythmias during 24 hour ambulatory electrocardiographic monitoring

Se evaluó la correlación entre síntomas y arrtmias que se presentaron durante un monitoreo electrocardiográfico de 24h en 1558 pacientes (790 varones y 768 mujeres) de 13 a 86 años de edad (media: 56,7 años). Se registraron arritmias ventriculares en 56,9% de los pacientes (886/1558) y arritmias supraventriculares en 26,6% (414/1558). Durante el período de registro sólo 32,5% de los pacientes (507/1558 refirieron síntomas sugestivos de alteraciones del ritmo. La diferencia en la incidencia de síntomas en los pacientes sin arritmias y con arritmias menores o arritmias mayores no fue estadísticamente significativa. Sólo el 16,6% de los pacientes sintomáticos (84/507) presentaron síntomas simultáneos con las arritmias y, en este grupo, los pacientes con arritmias supraventriculares y ventriculares menores presentaron una menor incidencia de síntomas que aquellos con arritmias supraventriculares o ventriculares mayores (p<0,001 y p<0,005, respectivamente). De ellos, 188 pacientes tuvieron síntomas asociados con registros normales que resultaron útiles para excluir arritmias como causa. Las mujeres presentaron más síntomas que los varones tuvieran o no arritmias (p<0,001) (AU)