Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 114
Filtrar
1.
Med. intensiva (Madr., Ed. impr.) ; 43(8): 464-473, nov. 2019. graf, tab
Artigo em Inglês | IBECS-Express | ID: ibc-ET2-3465

RESUMO

Purpose: To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. Materials and methods: A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. Results: A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. Conclusions: The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality


Objetivo: Determinar las diferencias en la mortalidad a corto y largo plazo en pacientes sépticos ancianos con síndrome de disfunción multiorgánica, y cuáles son los factores de riesgo determinantes de esta. Materiales y métodos: Estudio retrospectivo de cohortes de 206 pacientes mayores de 65 años con criterios de shock séptico y sepsis admitidos en la UCI del Hospital Río Hortega entre enero de 2011 y febrero de 2017. Los datos analizados se obtuvieron a través de los registros de bases de datos electrónicas de la unidad. Resultados: Se incluyeron 206 pacientes divididos en 3 grupos de edad (65-74; 75-85; >85). No encontramos diferencias estadísticas en la mortalidad por grupo de edad al cabo de 28 días, 90 días y un año (28,6, 32,1 y 45,2% en el grupo de 65-74 años; 32,5, 38,6 y 45,8% en el grupo de 75-85 años; 41, 48,7 y 56,4% en el grupo de edad >85) Los factores relacionados con la mortalidad fueron: insuficiencia cardíaca crónica, cáncer no hematológico, disfunción hepática y disfunción del sistema nervioso central. Conclusión: Los resultados indican que no hay una diferencia significativa en la mortalidad entre los diferentes grupos de edad. Alrededor del 50% de los pacientes ancianos sobreviven ante un proceso séptico. Existe una estrecha relación entre el número de órganos disfuncionantes, los días de disfunción, el uso de técnicas de intervención y la mortalidad a largo plazo

2.
Emergencias ; 31(5): 335-340, 2019 Oct.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31625305

RESUMO

OBJECTIVES: To analyze the safety of electric cardioversion performed for recent-onset atrial fibrillation in a hospital emergency department. MATERIAL AND METHODS: Observational retrospective analysis of consecutive emergency department cases of atrial fibrillation of less than 48 hours' duration in hemodynamically stable patients. All included cases were either treated with emergency electric cardioversion or referred for evaluation and scheduling of outpatient cardioversion. The outcome variable was the occurrence of a thromboembolic or hemorrhagic event within 90 days. RESULTS: A total of 718 cardioversions in 570 patients were analyzed. The mean (SD) age of the patients was 64 (13.5) years. Four hundred seventy-nine emergency cardioversions (66.7%) and 239 (33.3%) scheduled cardioversions were performed. Eleven adverse events (1.5% of the cohort) occurred: 2 were thromboembolic events (0.3%) and 9 were hemorrhagic (1.3%). All bleeds were minor. There were no statistically significant differences in the rate of adverse events between the emergency and scheduled cardioversion groups. CONCLUSION: Emergency cardioversion for recent-onset atrial fibrillation is safe.

3.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 335-340, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184123

RESUMO

Objetivo. Analizar la seguridad de la cardioversión de la fibrilación auricular (FA) de reciente comienzo realizada en un servicio de urgencias hospitalario (SUH). Método. Estudio observacional, retrospectivo y analítico en un SUH. Se recogieron de forma consecutiva los episodios de FA de menos de 48 horas de evolución y hemodinámicamente estables, en los que se realizó una cardioversión urgente (CVU) y los episodios derivados para valorar cardioversión programada ambulatoria (CVP). La variable de resultado fue la presencia de eventos embólicos (EE) o hemorrágicos (EH) a los 90 días. Resultados. Se analizaron 718 cardioversiones en 570 pacientes. La edad media fue de 64 años (DE 13,5). Se realizaron 479 (66,7%) CVU y 239 (33,3%) CVP. Se recogieron un total de 11 (1,5%) eventos: dos EE (0,3%) y 9 EH (1,3%). Todos los EH fueron hemorragias menores. No se encontraron diferencias estadísticamente significativas entre ambos grupos. Conclusión. La CVU de la FA de reciente comienzo en los SUH es una estrategia segura


Objective. To analyze the safety of electric cardioversion performed for recent-onset atrial fibrillation in a hospital emergency department. Methods. Observational retrospective analysis of consecutive emergency department cases of atrial fibrillation of less than 48 hours’ duration in hemodynamically stable patients. All included cases were either treated with emergency electric cardioversion or referred for evaluation and scheduling of outpatient cardioversion. The outcome variable was the occurrence of a thromboembolic or hemorrhagic event within 90 days. Results. A total of 718 cardioversions in 570 patients were analyzed. The mean (SD) age of the patients was 64 (13.5) years. Four hundred seventy-nine emergency cardioversions (66.7%) and 239 (33.3%) scheduled cardioversions were performed. Eleven adverse events (1.5% of the cohort) occurred: 2 were thromboembolic events (0.3%) and 9 were hemorrhagic (1.3%). All bleeds were minor. There were no statistically significant differences in the rate of adverse events between the emergency and scheduled cardioversion groups. Conclusion. Emergency cardioversion for recent-onset atrial fibrillation is safe


Assuntos
Humanos , Pessoa de Meia-Idade , Cardioversão Elétrica/instrumentação , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Cardioversão Elétrica/métodos , Cardioversão Elétrica/tendências , Segurança do Paciente , Estudos de Coortes , Estudos Retrospectivos , Análise Multivariada
4.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 227-233, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182762

RESUMO

Objetivos: Este estudio analiza el control del ritmo en los servicios de urgencias (SUH) y sus resultados en pacientes con fibrilación auricular (FA) de reciente comienzo, para identificar áreas de mejora en el manejo. Método: Estudio multicéntrico, observacional, prospectivo y transversal desarrollado en 124 SUH representativos del sistema sanitario español basado en el registro HERMES-AF (estrategias de manejo en el servicio de urgencias hospitalario de la FA) del 23 de mayo al 5 de junio de 2011. Se incluyeron pacientes con FA sintomática con menos de 48 h de evolución en los cuales se tomó la decisión de restaurar el ritmo sinusal. Resultados: Se incluyeron 337 pacientes, se optó por cardioversión farmacológica en 311 pacientes (92,3%), y por cardioversión eléctrica en 52 (15%), la mitad de los casos tras fracaso de los fármacos. Se obtuvo ritmo sinusal (RS) en 278 pacientes (82,5%) y el alivio de los síntomas en 297 (94%), con una tasa de efectos adversos del 0,9%, ninguno grave. Amiodarona se asoció de manera independiente a una menor tasa de RS al alta (OR = 0,442; IC 95% 0,238-0,823; p = 0,01), al contrario que la cardioversión eléctrica (OR = 4,0; IC 95% 1,2-13,3; p = 0,024). Los fármacos I-C se asociaron con una mayor proporción de altas en < 6 h (OR 2,6; IC 95% 1,6-4,3; p < 0,001) y amiodarona con más estancias prolongadas de > 24 h (OR 2,7, IC 95% 1,5-4,8; p < 0,003). Conclusiones: En los SUH, la restauración del RS en la FA de reciente comienzo es segura, efectiva y asocia beneficios clínicos para los pacientes. Reemplazar amiodarona por técnicas más efectivas y rápidas como la cardioversión eléctrica o los fármacos I-C es un área de mejora de la calidad asistencial


Objectives: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. Methods: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. Results: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P<.001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P<.003). Conclusions: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardioversão Elétrica/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Ritmo Circadiano/efeitos dos fármacos , Sistema de Registros/normas , Cardioversão Elétrica/tendências , Estudos Prospectivos , Estudos Transversais , Espanha , Antiarrítmicos/administração & dosagem , Sistemas de Saúde/organização & administração
5.
Emergencias ; 31(4): 227-233, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31347801

RESUMO

OBJECTIVES: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. MATERIAL AND METHODS: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. RESULTS: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P< .001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P< .003). CONCLUSION: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents.

6.
Front Plant Sci ; 10: 291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30918509

RESUMO

The hydraulic traits of plants, or the efficiency of water transport throughout the plant hydraulic system, could help to anticipate the impact of climate change and improve crop productivity. However, the mechanisms explaining the role of hydraulic traits on plant photosynthesis and thus, plant growth and yield, are just beginning to emerge. We conducted an experiment to identify differences in growth patterns at leaf, root and whole plant level among four wild olive genotypes and to determine whether hydraulic traits may help to explain such differences through their effect on photosynthesis. We estimated the relative growth rate (RGR), and its components, leaf gas exchange and hydraulic traits both at the leaf and whole-plant level in the olive genotypes over a full year. Photosynthetic capacity parameters were also measured. We observed different responses to water stress in the RGRs of the genotypes studied being best explained by changes in the net CO2 assimilation rate (NAR). Further, net photosynthesis, closely related to NAR, was mainly determined by hydraulic traits, both at leaf and whole-plant levels. This was mediated through the effects of hydraulic traits on stomatal conductance. We observed a decrease in leaf area: sapwood area and leaf area: root area ratios in water-stressed plants, which was more evident in the olive genotype Olea europaea subsp. guanchica (GUA8), whose RGR was less affected by water deficit than the other olive genotypes. In addition, at the leaf level, GUA8 water-stressed plants presented a better photosynthetic capacity due to a higher mesophyll conductance to CO2 and a higher foliar N. We conclude that hydraulic allometry adjustments of whole plant and leaf physiological response were well coordinated, buffering the water stress experienced by GUA8 plants. In turn, this explained their higher relative growth rates compared to the rest of the genotypes under water-stress conditions.

7.
Acad Emerg Med ; 26(9): 1034-1043, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30703274

RESUMO

BACKGROUND: Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF. METHODS: This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 emergency departments (EDs). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms. RESULTS: Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control of symptoms was achieved in 396 (94.1%) patients and was associated with a heart rate after treatment ≤ 110 beats/min (odds ratio [OR] = 14.346, 95% confidence interval [CI] = 3.90 to 52.70, p < 0.001) and a rhythm control strategy (OR = 2.78, 95% CI = 1.02 to 7.61, p = 0.046). Sixty patients (14.2%) were admitted: discharge was associated with a rhythm control strategy (OR = 2.22, 95% CI = 1.20-4.60, p = 0.031) and admission was associated with a heart rate > 110 beats/min after treatment (OR = 29.71, 95% CI = 7.19 to 123.07, p < 0.001) and acute heart failure (OR = 9.45, 95% CI = 2.91 to 30.65, p < 0.001). CONCLUSION: In our study, recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.

8.
Carbohydr Polym ; 203: 103-109, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30318193

RESUMO

Xanthan gum solutions are used in the oil industry for flooding, drilling and completion operations. The stabilization of the structure of xanthan gum solutions in presence of salts increases the value of both the order-disorder transition temperature and the gel strength. This effect is very important in order to design drilling and completion fluids since not only density and viscosity of the fluid can be improved by increasing the concentration of salts but also the range of temperature where the solution shows viscoelastic behaviour can be extended. This paper presents results from a study on the rheological behaviour of xanthan gum solutions in different saturated brines. Chloride and formate potassium brines not only increase the viscosity of the solution but also extend the shear thinning behaviour to temperatures near 200 °C, maintaining a simple relaxation mechanism over the whole range of temperature where the ordered conformation dominates the rheological behaviour.

9.
Med Intensiva ; 43(8): 464-473, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30025749

RESUMO

PURPOSE: To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. MATERIALS AND METHODS: A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. RESULTS: A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. CONCLUSIONS: The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality.

10.
Rev. esp. cardiol. (Ed. impr.) ; 71(7): 553-564, jul. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178581

RESUMO

En los últimos años, el número de pacientes anticoagulados y antiagregados está aumentando significativamente. Al ser un tratamiento crónico, es de esperar que a lo largo de su vida necesiten un procedimiento quirúrgico o intervencionista que pueda requerir la interrupción del fármaco antitrombótico. La decisión de retirar o mantener dicho tratamiento estará determinada, por un lado, por el riesgo trombótico y, por otro, por el hemorrágico. De la interacción entre estos 2 factores dependerá la actitud ante la anticoagulación y la antiagregación. El objetivo de este documento de consenso, coordinado desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología y certificado por un amplio número de sociedades científicas que participan en el proceso asistencial del paciente durante el periodo perioperatorio o periprocedimiento, consiste en proponer una serie de recomendaciones prácticas y sencillas con el fin de homogeneizar la práctica clínica diaria


During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice


Assuntos
Humanos , Trombose/prevenção & controle , Fibrinolíticos/administração & dosagem , Anticoagulantes/administração & dosagem , Inibidores da Agregação de Plaquetas/administração & dosagem , Tromboembolia/prevenção & controle , Período Perioperatório , Suspensão de Tratamento , Padrões de Prática Médica
11.
Rev Esp Cardiol (Engl Ed) ; 71(7): 553-564, 2018 Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29887180

RESUMO

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.


Assuntos
Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Hemorragia/etiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Tromboembolia/etiologia , Idoso , Idoso de 80 Anos ou mais , Substituição de Medicamentos , Feminino , Hemorragia/prevenção & controle , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Cuidados Pré-Operatórios/métodos , Medição de Risco , Fatores de Risco , Tromboembolia/prevenção & controle
15.
Int J Biol Macromol ; 112: 996-1004, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29438755

RESUMO

The aim of this work was to elucidate the influence of egg white albumen (EA) protein loaded on the electrospinning of PEO solutions under different concentrations and pHs conditions. Properties of the electrospun fiber mats, such as morphology, thermal properties, and wettability were analyzed. In addition, rheological behavior of the polymer solutions was measured to explain the electrospinnability for fiber formation. The rheological results showed that the addition of EA protein affects the molecular entanglement required to electrospin PEO, being able to incorporate up to 75wt% EA protein. The diameter of most of the PEO/EA fibers was in the range of 200-400nm. When comparing the effect of concentration and pH of the electrospinning solution, the morphology of the fibers was found to be mainly affected by the second one. FTIR analysis of the blend fibers confirmed the presence of the protein and revealed that the secondary structure changed with pH. From a thermodynamic point of view, the EA protein and PEO showed a high degree of mutual incompatibility. The presence of EA protein influenced PEO polymer thermal behavior, lowering its melting point and decreasing the quantity of PEO crystallites. All the PEO/EA electrospun fiber mats showed rapid water absorption, which increased as PEO concentration became higher, and similarly, when lowering protein concentration.


Assuntos
Albuminas/metabolismo , Óvulo/metabolismo , Polietilenoglicóis/farmacologia , Animais , Varredura Diferencial de Calorimetria , Concentração de Íons de Hidrogênio , Polietilenoglicóis/química , Pós , Reologia , Soluções , Espectroscopia de Infravermelho com Transformada de Fourier , Temperatura Ambiente , Termogravimetria , Viscosidade , Água/química , Molhabilidade
16.
Carbohydr Polym ; 181: 63-70, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29254016

RESUMO

The influence of concentration on the shear and extensional rheology properties of aqueous solutions of xanthan and guar gums was studied in this work. Shear rheology involved small amplitude oscillatory shear (SAOS), flow curves and transient flow, while the extensional rheology was analyzed using hyperbolic contraction flow. In addition, the mechanical properties during solutions manufacture were monitored in situ through the evolution of torque with processing time by mixing rheometry. The results showed that the hydrocolloids exert a great influence on the process rheokinetics and on the resulting rheological response. SAOS tests showed that the xanthan gum solutions behaved as weak gels, whereas guar gum solutions suggest the presence of entanglement and the formation of a viscoelastic, gel-like structure. All the systems exhibited shear-thinning behaviour. Guar gum solutions obeyed the Cox-Merz rule, with some divergence at high rates for the more concentrated solutions, while the Cox-Merz rule was not followed for xanthan gum in the range of concentration studied. The extensional viscosity exhibited an extensional-thinning behaviour within the strain range used and all solutions were characterized by a high Trouton ratio.

17.
Emergencias ; 29(1): 18-26, 2017 02.
Artigo em Espanhol | MEDLINE | ID: mdl-28825264

RESUMO

OBJECTIVES: To evaluate the level of agreement between hematologists and emergency medicine physicians regarding the best clinical practices for managing bleeding and anticoagulant reversal. MATERIAL AND METHODS: Nationwide Spanish multicenter Delphi method study with a panel of experts on anticoagulation and the management of bleeding. Two survey rounds were carried out between April and September 2015. Consensus was reached when more than 75% of the panelists scored items in the same tertile. RESULTS: Fifteen hematologists and 17 emergency medicine specialists from 14 Spanish autonomous communities participated. Consensus was reached on the use of both hemodialysis and an activated prothrombin complex concentrate (PCC) to antagonize significant/major bleeding in patients taking dabigatran. Use of an activated PCC was considered sufficient for patients on rivaroxaban or apixaban. The panel did not consider any PCC to be both effective and safe. Tests for activated partial thromboplastin, thrombin, diluted thrombin, and ecarin clotting times were considered useful in patients treated with dabigatran. A specific anti-Xa activity assay was suggested for patients who developed bleeds while treated with rivaroxaban or apixaban. Specific antidotes for direct-acting oral anticoagulants would be useful when severe bleeding occurs according to 97% of the panelists. Such antidotes would substantially change current treatment algorithms. CONCLUSION: The points of consensus were generally in line with clinical practice guidelines, but the Delphi process revealed that there are aspects of the clinical management of bleeding that require unified criteria. The need for specific antidotes for direct-acting oral anticoagulants was emphasized.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/terapia , Padrões de Prática Médica , Administração Oral , Adulto , Idoso , Anticoagulantes/administração & dosagem , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Testes de Coagulação Sanguínea , Transfusão de Sangue , Carvão Vegetal/uso terapêutico , Técnica Delfos , Gerenciamento Clínico , Medicina de Emergência , Fator VIII/uso terapêutico , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Feminino , Fibrinogênio/uso terapêutico , Hematologia , Hemorragia/induzido quimicamente , Hemorragia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia
18.
Stroke ; 48(5): 1344-1352, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28389612

RESUMO

BACKGROUND AND PURPOSE: Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients. METHODS: Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion. Follow-up at 1 year post-discharge included data about thromboprophylaxis and its complications, major bleeding, and death; risk was assessed with univariate and bivariate logistic regression models. RESULTS: We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA2DS2-VASc score. At ED discharge, 935 patients (80.5%) were receiving anticoagulant therapy, de novo in 237 patients (55.2% of 429 not previously treated). At 1 year, 48 (4.1%) patients presented major bleeding events, and 151 (12.9%) had died. Anticoagulation first prescribed in the ED was not related to major bleeding (hazard ratio, 0.976; 95% confidence interval, 0.294-3.236) and was associated with a decrease in mortality (hazard ratio, 0.398; 95% confidence interval, 0.231-0.686). Adjusting by the main clinical and sociodemographic characteristics, concomitant antiplatelet treatment, or destination (discharge or admission) did not affect the results. CONCLUSIONS: Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.


Assuntos
Anticoagulantes/farmacologia , Fibrilação Atrial/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Espanha/epidemiologia , Acidente Vascular Cerebral/mortalidade
19.
Endocrinol Diabetes Nutr ; 64(1): 34-39, 2017 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28440768

RESUMO

OBJECTIVE: To report the clinical characteristics of patients with latent autoimmune diabetes in adults (LADA), and to ascertain their metabolic control and associated chronic complications. METHODS: Patients with DM attending specialized medical care in Madrid who met the following criteria: age at diagnosis of DM >30years, initial insulin independence for at least 6months and positive GAD antibodies were enrolled. Clinical profiles, data on LADA diagnosis, associated autoimmunity, C-peptide levels, therapeutic regimen, metabolic control, and presence of chronic complications were analyzed. RESULTS: Number of patients; 193; 56% females. Family history of DM: 62%. Age at DM diagnosis: 49years. Delay in confirmation of LADA: 3.5years. Insulin-independence time: 12months. Baseline serum C-peptide levels: 0.66ng/ml. Basal-bolus regimen: 76.7%. Total daily dose: 35.1U/day, corresponding to 0.51U/Kg. With no associated oral antidiabetic drugs: 33.5%. Other autoimmune diseases: 57%. Fasting plasma glucose: 160.5mg/dL. HbA1c: 7.7%. BMI: 25.4kg/m2 (overweight, 31.5%; obesity, 8%). Blood pressure: 128/75. HDL cholesterol: 65mg/dL. LDL cholesterol: 96mg/dL. Triglycerides: 89mg/dL. Known chronic complications: 28%. CONCLUSIONS: Recognition of LADA may be delayed by several years. There is a heterogeneous pancreatic insulin reserve which is negative related to glycemic parameters. Most patients are poorly controlled despite intensive insulin therapy. They often have overweight, but have adequate control of BP and lipid profile and a low incidence of macrovascular complications.


Assuntos
Diabetes Autoimune Latente em Adultos/metabolismo , Adulto , Idade de Início , Autoanticorpos/sangue , Autoantígenos/imunologia , Glicemia/análise , Pressão Sanguínea , Peptídeo C/análise , Estudos Transversais , Complicações do Diabetes/epidemiologia , Feminino , Glutamato Descarboxilase/imunologia , Humanos , Insulina/uso terapêutico , Diabetes Autoimune Latente em Adultos/tratamento farmacológico , Diabetes Autoimune Latente em Adultos/imunologia , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Sobrepeso , Estudos Retrospectivos , Espanha/epidemiologia
20.
Sci Technol Adv Mater ; 18(1): 60-67, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28179959

RESUMO

Au nanorods were used as plasmonic transducers for investigation of mercury detection through a mechanism of amalgam formation at the nanorod surfaces. Marked scattering color transitions and associated blue shifts of the surface plasmon resonance peak wavelengths (λmax) were measured in individual nanorods by darkfield microscopy upon chemical reduction of Hg(II). Such changes were related to compositional changes occurring as a result of Hg-Au amalgam formation as well as morphological changes in the nanorods' aspect ratios. The plot of λmax shifts vs. Hg(II) concentration showed a linear response in the 10-100 nM concentration range. The sensitivity of the system was ascribed to the narrow width of single nanorod scattering spectra, which allowed accurate determination of peak shifts. The system displayed good selectivity as the optical response obtained for mercury was one order of magnitude higher than the response obtained with competitor ions. Analysis of mercury content in river and tap water were also performed and highlighted both the potential and limitation of the developed method for real sensing applications.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA