Diagnosis and treatment of deep vein thrombosis of the lower and upper limbs. 2024 recommendations of the venous thromboembolism group of the Spanish Society of Internal Medicine.

Deep vein thrombosis (DVT) of the limbs is a common disease and causes significant morbidity and mortality. It is frequently the prelude to pulmonary embolism (PE), it can recur in 30% of patients and in 25-40% of cases they can develop post-thrombotic syndrome (PTS), with a significant impact in functional status and quality of life. This document contains the recommendations on the diagnosis and treatment of acute DVT from the Thromboembolic Disease group of the Spanish Society of Internal Medicine (SEMI). PE and thrombosis of unusual venous territories (cerebral, renal, mesenteric, superficial, etc.) are outside its scope, as well as thrombosis associated with catheter and thrombosis associated with cancer, which due to their peculiarities will be the subject of other positioning documents of the Thromboembolic Disease group of the Spanish Society of Internal Medicine (SEMI).

Focused ultrasound solid-liquid extraction for the determination of organic biomarkers in beachrocks.

Beachrocks are consolidated coastal sedimentary formations resulting mainly from the relative rapid cementation of beach sediments by different calcium carbonate polymorphs. Although previous works have already studied the elemental composition and the mineral phases composing these cements, few of them have focused their attention on the organic matter present therein. This work describes an extraction methodology based on focused ultrasound solid-liquid extraction (FUSLE), followed by analysis using large volume injection (LVI) in a programmable temperature vaporizer (PTV) combined with gas chromatography-mass spectrometry (GC-MS) in order to determine organics such as polycyclic aromatic hydrocarbons (PAHs) and biomarkers (hopanes), which can increase and confirm the information obtained so far. This goal has been achieved after the optimization of the main parameters affecting the extraction procedure, such as, extraction solvent, FUSLE variables (amplitude, extraction time and pulse time) and also variables affecting the LVI-PTV (vent time, injection speed and cryo-focusing temperature). The developed method rendered results comparable to traditional extraction methods in terms of accuracy (77-109%) and repeatability (RSD<23%). Finally, the analyses performed over real beachrock samples from the Bay of Biscay (Northern Spain) revealed the presence of the 16 EPA priority PAHs, as well as some organic biomarkers which could increase the knowledge about such beachrock formation.

[Scope of the latest RE-LY substudies: clinical implications]. / Alcance de los últimos subestudios del RE-LY: implicaciones clínicas.

The approval of the use of dabiatran in stroke prevention in patients with nonvalvular atrial fibrilation (NVAF) is based on the results of the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, one of the largest studies to date in this entity. In this trial, dabigatran showed similar safety and efficacy to warfarin in primary and secondary prevention of stroke in patients with AF. At a dose of 150 mg twice daily, dabigatran was superior to warfarin in the prevention of stroke or systemic embolism and the 110 mg dose twice daily showed similar efficacy and greater safety, given the lower incidence of hemorrhage. These results were consistently found in the various subanalyses, with some slight differences of interest for clinical practice. The ideal candidates for dabiatran are patients with NVAF suitable for cardioversion, who require short periods of anticoagulation, patients in remote geographical areas with difficulty in achieving good anticoagulation control or good control with anti-vitamin K treatment due to IRN fluctuations, and patients with a low risk of hemorrhage and a CHADS score ≥ 3 and/or with prior stroke, whenever there are no contraindications. The choice of dabigatran dose should be evaluated according to the patient's individual characteristics (caution must be exercised when prescribing this drug in the elderly and in renal insufficiency) and embolic and/or hemorrhagic risk. Studies of the long-term safety of this drug, pharmacoeconomic analyses in Spain and post-commercialization pharmacovigilance data are required before the definitive uses of this drug can be established.

Alcance de los últimos subestudios del RE-LY: implicaciones clínicas / Scope of the latest RE-LY substudies: clinical implications

La aprobación de etexilato de dabigatrán en la prevención del ictus en pacientes con fibrilación auricular no valvular (FANV) se fundamenta en los resultados del ensayo RE-LY, uno de los mayores estudios realizados hasta la fecha en esta patología. En este estudio, dabigatrán ha demostrado ser una alternativa eficaz y segura a la warfarina para la prevención primaria y secundaria del ictus en pacientes con FA. Dabigatrán en dosis de 150 mg 2 veces al día resultó superior a la warfarina en la prevención de ictus o embolias sistémicas y la dosis de 110 mg 2 veces al día demostró similar eficacia con mayor seguridad, dada la menor incidencia de hemorragia. Dichos resultados se mantienen consistentes en los diferentes subanálisis con algunos matices de interés para la práctica clínica. Los candidatos ideales para dabigatrán serían los pacientes con FANV subsidiarios de cardioversión, que requieren períodos cortos de anticoagulación, pacientes en zonas geográficas alejadas con dificultad para acceder a un buen control de la anticoagulación o difíciles de controlar con AVK por fluctuación del cociente internacional normalizado (INR), y pacientes con bajo riesgo de hemorragias, con score de CHADS≥ 3 o/ y con ictus previo, siempre que lógicamente no exista contraindicación. La elección de dosis de dabigatrán será valorada en función de las características individuales (precaución con los ancianos y en insuficiencia renal) y del riesgo embólico y/ o hemorrágico en cada paciente. Aspectos relacionados con la seguridad a largo plazo, estudios de farmacoeconomía en España y datos de farmacovigilancia poscomercialización son necesarios para posicionar definitivamente este fármaco (AU)

The approval of the use of dabiatran in stroke prevention in patients with nonvalvular atrial fibrilation (NVAF) is based on the results of the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, one of the largest studies to date in this entity. In this trial, dabigatran showed similar safety and efficacy to warfarin in primary and secondary prevention of stroke in patients with AF. At a dose of 150 mg twice daily, dabigatran was superior to warfarin in the prevention of stroke or systemic embolism and the 110 mg dose twice daily showed similar eficacy and greater safety, given the lower incidence of hemorrhage. These results were consistently found in the various subanalyses, with some slight differences of interest for clinical practice. The ideal candidates for dabiatran are patients with NVAF suitable for cardioversion, who require short periods of anticoagulation, patients in remote geographical areas with difficulty in achieving good anticoagulation control or good control with anti-vitamin K treatment due to IRN fluctuations, and patients with a low risk of hemorrhage and a CHADS score ≥ 3 and/ or with prior stroke, whenever there are no contraindications. The choice of dabigatran dose should be evaluated according to the patient’s individual characteristics (caution must be exercised when prescribing this drug in the elderly and in renal insufficiency) and embolic and/or hemorrhagic risk. Studies of the long-term safety of this drug, pharmacoeconomic analyses in Spain and post-commercialization pharmacovigilance data are required before the definitive uses of this drug can be established (AU)

Mortalidad precoz en un hospital terciario: análisis de la calidad asistencial / Early mortality in a tertiary care hospital: analysis of quality of care

Objetivos: Describir y analizar las características clínico-epidemiológicas y el proceso asistencial de los pacientes que fallecen durante las primeras 24 horas tras su llegada a urgencias. Método: Estudio unicéntrico descriptivo de todos los pacientes fallecidos durante las primeras 24 horas tras su llegada a urgencias durante el año 2009. Se compararon según el lugar del fallecimiento (urgencias o planta) el tipo de paciente (terminal o no) ys e analizó la calidad asistencial prestada. Resultados: Se produjeron 164 fallecimientos, 81 de ellos en hospitalización y 83 en urgencias(tasa de mortalidad 0,091%). La edad media de los pacientes fue de 78,4 ± 14,7años, el 54,9% fueron mujeres, el 85% tenía alguna comorbilidad importante y el índicede Karnofsky medio fue de 66,1 ± 23,7. El 24,7% de sujetos se encontraba en fase terminal de su enfermedad. En el 82,2% de los casos el fallecimiento fue previsible a la llegada del paciente a urgencias. Las principales causas de muerte fueron las enfermedades cerebrovasculares(17,3%), seguidas de las neumonías (16,7%) y las septicemias (13,6%). La ubicación de los pacientes se consideró adecuada en el 98,8% de casos. Recibieron tratamiento con analgésicos opiáceos o sedación con mayor frecuencia los pacientes en fase terminal (64,1 frente a 34,2%, p < 0,05). En el 97,1% de casos se informó a los familiares acerca del pronóstico del paciente, y en el 87% éste se encontraba acompañado. Conclusiones: Dada la creciente demanda asistencial de pacientes afectados de patologías terminales, el análisis de su proceso asistencial permite garantizar las medidas de confort para ellos, con el fin de maximizar la calidad percibida por los enfermos y sus familiares (AU)

Objective: To describe and analyze the clinical and epidemiologic characteristics of the care process of patients who died within 24 hours of arriving at emergency department. Methods: Descriptive single-centre study of patients who died in the first 24 hours of arrival at our emergency department in 2009.Results: A total of 164 deaths occurred; 84 patients died after admission to a ward and 83 were in the emergency department (mortality rate, 0.091%). The mean (SD) age of these patients was 78.4 (14.7) years; 54.9% were women and 85% had a significant comorbid condition. The mean Karnofsky index was 66.1 (23.7). The terminal stage of adisease had been reached by 24.7% of the patients, and death was foreseen on the patient’s arrival in the emergency department in 82.2%. The most frequent cause of death was cerebrovascular disease (17.3%), followed by pneumonia(16.7%) and septicemia (13.6%). Patients were admitted to an appropriate place in 98.8% of the cases. Treatment with opioid analgesics or sedation was most often provided for patients in a terminal phase (64.1% vs 34.2%, P<.05). Families were informed about the patient’s prognosis in 97.1% of the cases; 87% of the patients were accompanied by a relative. Conclusions: Given that the demand for care of patients in terminal phases of disease is growing, analysis of the care process will allow us to ensure that measures are implemented to make them and their families as comfortable as possible (AU)

Beachrock formation in temperate coastlines: examples in sand-gravel beaches adjacent to the Nerbioi-Ibaizabal Estuary (Bilbao, Bay of Biscay, North of Spain).

Beachrocks are coastal sedimentary formations resulting from a relative rapid cementation of beach sediments by the precipitation of carbonate cements. These lithified structures are not usually observed at temperate settings. The present work is focused on the occurrence of a significant intertidal cementation in sand-gravel beaches formed among 43°N latitude coastline, close to the Nerbioi-Ibaizabal estuary (Bilbao, Bay of Biscay, North of Spain). Raman micro-spectroscopy combined with SEM-EDX analyses and petrographic descriptions have been applied for the determination of the cement generations and the cemented materials compositions of the beachrock outcrops. In general terms, the cements described were: Cement Generation 1 (CG 1, aragonite, high-magnesium calcite and silicate mixtures), Cement Generation 2 (CG 2, aragonite) and Cement Generation 3 (CG 3, mixtures of CaCO(3) polymorphs and iron oxides). The rest of the interstitial porosity of the rocks appeared either empty or filled with heterogeneous cemented mixtures of previously reworked compounds. The mineralogy, the regular distribution and the isopachous character of the carbonate cements together with the accurate cementation at advanced seaward bands propose a possible marine-phreatic context for the beachrock formation. However, the impure cements and the materials covering the interstitial porosity seem to be the result of both, the weathering actions consequences and the surface alterations of specific grains. Moreover, the presence of modern cemented materials (e.g. slag, bricks and pebbles) suggest a recent formation of the phenomenon.

Micro-Raman spectroscopic identification of natural mineral phases and their weathering products inside an abandoned zinc/lead mine.

Mining activities provide a good source of minerals of different nature. On the one hand, the primary minerals for whose formation a geological time-scale is required. On the other hand, secondary minerals, formed from removed products after the earlier weathering and alteration states. These are characteristic of the local geology and the environment context that commonly appears due to the low chemical stability of their original primary minerals. This work shows how quickly the reactions promoting secondary minerals may have taken place, due to the fact that these were found in newly formed solid materials called efflorescences. To achieve this purpose, the sampling is crucial. It was carried out in such a way that tried to guarantee that the samples collected consisted in the very top soil matter (first 2 cm depth). Thus, unlike the deeper soil, the material analysed may have been newly formed due to the interactions that they had with the place weathering agents (i.e. air oxygen, humidity, and microbial activities). Raman spectroscopy has emerged as a good and fast non-destructive technique that provides molecular information of the local mineralogy without the need of any pre-treatment of the samples. At the same time, the work looked for information on the variety of non-stable lead and-or zinc containing minerals due to the possible health and environmental risks they convey. Among the different minerals identified, 16 were of primary nature while 23 may be classified as secondary minerals, probably formed in the last decades as the result of the extractive activities.

Carcinoma suprarrenal. Presentación de un caso y revisión de la literatura / No disponible

No disponible

[Activity of a short-stay observation unit in an emergency department of a tertiary hospital. A two-year experience]. / Actividad de una unidad de observación en un servicio de urgencias de un hospital terciario: dos años de experiencia.

OBJECTIVES: To describe the characteristics of the activity of a short stay observation unit (SSOU) in a tertiary hospital, and to analyze its influence on the hospitalization rate. MATERIAL AND METHODS: The activity of the SSOU during the first 2 years after opening is described. Descriptive variables were registered. Hospitalization activity during the first 5 months after opening the unit was compared with the activity during the same period in the previous year. RESULTS: From June 1, 2001 to May 31, 2003, 74,989 patients were admitted to the emergency department (ED) and 2,438 (3.25 %) were transferred to the SSOU. The mean age of the patients was 64.55 months. The mean length of stay was 5 hours and 50 minutes. The main discharge diagnoses were gastrointestinal disease (30.2 %), accidents (15 %), respiratory illness (12.5 %) and febrile syndrome (9.8 %). The hospitalization rate in patients admitted to the ED was 5.8 % from June 1, 2000 to October 1, 2000 and was 4.28 % in the same period in 2001. The mean diagnosis-related group (DRG)-weight was 0.8648 in 2000 and was 0.9078 in 2001. Total weight was 680.66 in 2000 and 495.69 in 2001, allowing an approximate saving of 329,162 Euros. CONCLUSIONS: The opening of the SSOU has been useful in the assessment and treatment of common childhood diseases and has helped reduce the hospitalization rate, increase the complexity of inpatients and lower costs.

Actividad de una unidad de observación en un servicio de urgencias de un hospital terciario: dos años de experiencia / Activity of a short-stay observation unit in an emergency department of a tertiary hospital. A two-year experience

Objetivos: Exponer las características de la actividad de la unidad de observación de un hospital terciario y analizar los cambios derivados de ello en la hospitalización. Material y métodos: Se describe la actividad de dicha unidad en los primeros 2 años, recogiendo diferentes variables descriptivas. Posteriormente, se compara la actividad hospitalaria en la planta durante los primeros 5 meses tras su instauración, con el mismo período del año anterior, cuando no existía esa unidad. Resultados: En el período comprendido entre el 1 de junio de 2001 y el 31 de mayo de 2003 se atendieron 74.989 urgencias, de las cuales 2.438 (3,25 %) se valoraron en la unidad de observación. La edad media de los pacientes fue de 64,55 meses. La estancia media se sitúa en las 5 h y 50 min. Los diagnósticos al alta fueron asignados a patología digestiva (30,2 %), accidentes (15 %), patología respiratoria (12,5 %) y síndrome febril (9,8 %). En el período de junio a octubre de 2000 ingresaron en el servicio de pediatría el 5,8 % de pacientes atendidos en urgencias, por un 4,28 % del mismo período del año 2001. El peso medio de los ingresos en el año 2000 fue 0,8648, y en 2001 fue 0,9078. El peso total de los ingresos del año 2000 fue 680,66 y del 2001 de 495,69, lo que se traduce en un ahorro aproximado de 329.162 d. Conclusiones: La instauración de una unidad de observación ha sido útil en el manejo de patología frecuente en la infancia y ha contribuido, en nuestro hospital, a una disminución en el número de ingresos, una mayor complejidad de los pacientes ingresados y una disminución del gasto

Objectives: To describe the characteristics of the activity of a short stay observation unit (SSOU) in a tertiary hospital, and to analyze its influence on the hospitalization rate. Material and methods: The activity of the SSOU during the first 2 years after opening is described. Descriptive variables were registered. Hospitalization activity during the first 5 months after opening the unit was compared with the activity during the same period in the previous year. Results: From June 1, 2001 to May 31, 2003, 74,989 patients were admitted to the emergency department (ED) and 2,438 (3.25 %) were transferred to the SSOU. The mean age of the patients was 64.55 months. The mean length of stay was 5 hours and 50 minutes. The main discharge diagnoses were gastrointestinal disease (30.2 %), accidents (15 %), respiratory illness (12.5 %) and febrile syndrome (9.8 %). The hospitalization rate in patients admitted to the ED was 5.8 % from June 1, 2000 to October 1, 2000 and was 4.28 % in the same period in 2001. The mean diagnosis-related group (DRG)-weight was 0.8648 in 2000 and was 0.9078 in 2001. Total weight was 680.66 in 2000 and 495.69 in 2001, allowing an approximate saving of 329,162 d. Conclusions: The opening of the SSOU has been useful in the assessment and treatment of common childhood diseases and has helped reduce the hospitalization rate, increase the complexity of inpatients and lower costs

[Supravalvular aortic stenosis. Apropos of 10 cases]. / Estenosis aórtica supravalvular. A propósito de 10 casos.

We present 10 patients diagnosed of supravalvular aortic stenosis (5 dumb bell shaped, 4 membranous and 1 undifferentiated), 7 in association with Williams-Beuren syndrome, 5 were male and 5 were female. None showed alterations of calcium metabolism and in 8 cases we found other associated cardiac anomalies. In 9, the diagnosis was confirmed with Eco-Doppler. The gradient calculated with the Eco-Doppler had a medium correlation (75%) with the catheterism (Doppler 46 +/- 23 (13-89)-Catheterism 27 +/- 15 (10-50)). 50% had the sinus of Valsalva dilated. Six patients underwent surgery, 5 with an enlargement parch and 1 with a butterfly parch. In 3 cases, associated anomalies were repaired, 2 during supravalvular surgery (one valvular aortic stenosis and one fixed subaortic stenosis). No patient had postoperatory complications.

[Aortic valva atresia with normal left ventricle and interventricular communication]. / Atresia aórtica con ventrículo izquierdo normal y comunicación interventricular.

We present three patients with aortic atresia, normal left ventricle and ventricular septal defect by bidimensional echocardiography. In two patients the Norwood's procedure was performed, but they died in the immediate postoperative time. The different procedures for the correction of this kind of aortic atresia and the necessity of prompt surgical treatment are discussed here.