Eutanasia y suicidio asistido en enfermedades neurológicas: una revisión sistemática / Euthanasia and assisted suicide in neurological diseases: a systematic review

Objetivo Identificar las enfermedades neurológicas por las que con mayor frecuencia se solicita la eutanasia y el suicidio asistido en los países donde están legalizados, las particularidades de la eutanasia en algunas de ellas y mostrar la evolución de sus cifras. Métodos Revisión bibliográfica sistemática. Resultados Las demencias, enfermedad de motoneurona, esclerosis múltiple y enfermedad de Parkinson son las enfermedades neurológicas que más frecuentemente motivan la petición de eutanasia o suicidio asistido. Las solicitudes por demencia son las más numerosas, están creciendo y plantean problemas éticos y legales adicionales al disminuir la capacidad de decisión. En algunos países la proporción de solicitudes respecto al total de casos de esclerosis múltiple, enfermedad de motoneurona o enfermedad de Huntington es mayor que en cualquier otra enfermedad. Conclusiones Después del cáncer las enfermedades neurológicas son el motivo más frecuente de pedir la eutanasia y el suicidio asistido. (AU)

Objective To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. Methods We conducted a systematic literature review. Results Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Claims related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients’ diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. Conclusions After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide. (AU)

Euthanasia and assisted suicide in neurological diseases: a systematic review.

OBJECTIVE: To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS: We conducted a systematic literature review. RESULTS: Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Requests related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS: After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.

La asistencia telefónica de las enfermedades neurológicas: una revisión sistemática / Telephone assistance for neurological diseases: a systematic review

Introducción y objetivo: Es conocido que parte de la asistencia a los pacientes neurológicos se presta por teléfono, pero desconocemos las enfermedades que se atienden de esta manera y qué partes de la asistencia se proporcionan así. Pretendemos averiguarlo a través de esta revisión bibliográfica. Materiales y métodos: Se han revisado sistemáticamente las referencias sobre asistencia telefónica a enfermedades neurológicas accesibles a través de las plataformas PubMed, Embase y Cochrane, sin fecha de inicio y hasta el 3 de abril de 2022. Se encontraron 618 referencias, de las que 219 no pasaron los criterios de exclusión, por lo que se revisaron 399. Resultados: Hay un aumento de publicaciones en los últimos años y, aunque la demencia no es la enfermedad más prevalente, es el área de la neurología con más publicaciones sobre asistencia telefónica. Le siguen los ictus, el traumatismo craneoencefálico, la esclerosis múltiple, la enfermedad de Parkinson y trastornos del movimiento, la epilepsia, las enfermedades neuromusculares y otras. Discusión y conclusiones. Las demencias son las enfermedades con más referencias bibliográficas sobre su asistencia telefónica a pesar de no ser las más prevalentes. Con frecuencia, el teléfono se utiliza para administrar escalas diagnósticas o apoyar a los cuidadores, y es especialmente útil en enfermedades que dificultan la movilidad y acudir presencialmente.(AU)

Introduction and aim: While part of the care for neurological patients is done by telephone, it is not well known what neurological diseases and which part of that care is provided by telephone. Our goal is to find it out through a bibliographic review. Materials and methods: References on telephone care for neurological diseases accessible through the PubMed, Embase, and Cochrane platforms have been systematically reviewed, with an unspecified start date and up to March 2022. We found 618 references, and as 219 did not pass the exclusion criteria, 399 were finally included in the review. Results: Dementia is the area of neurology with more publications about its telephone assistance. It is followed by stroke, head trauma, multiple sclerosis, Parkinson’s disease and movement disorders, epilepsy, neuromuscular disorders, and others. Discussion and conclusions: Dementias are the diseases with more bibliographic references on their telephone assistance despite not being the most prevalent. The telephone is frequently used to administer diagnostic scales or support caregivers and is particularly useful in diseases that limit mobility and attending a medical practice.(AU)

[Telephone assistance for neurological diseases: a systematic review]. / La asistencia telefónica de las enfermedades neurológicas: una revisión sistemática.

INTRODUCTION AND OBJECTIVE: While part of the care for neurological patients is done by telephone, it is not well known what neurological diseases and which part of that care is provided by telephone. Our goal is to find it out through a bibliographic review. MATERIALS AND METHODS: References on telephone care for neurological diseases accessible through the PubMed, Embase, and Cochrane platforms have been systematically reviewed, with an unspecified start date and up to March 2022. We found 618 references, and as 219 did not pass the exclusion criteria, 399 were finally included in the review. RESULTS: Dementia is the area of neurology with more publications about its telephone assistance. It is followed by stroke, head trauma, multiple sclerosis, Parkinson's disease and movement disorders, epilepsy, neuromuscular disorders, and others. DISCUSSION AND CONCLUSIONS: Dementias are the diseases with more bibliographic references on their telephone assistance despite not being the most prevalent. The telephone is frequently used to administer diagnostic scales or support caregivers and is particularly useful in diseases that limit mobility and attending a medical practice.

TITLE: La asistencia telefónica de las enfermedades neurológicas: una revisión sistemática.Introducción y objetivo. Es conocido que parte de la asistencia a los pacientes neurológicos se presta por teléfono, pero desconocemos las enfermedades que se atienden de esta manera y qué partes de la asistencia se proporcionan así. Pretendemos averiguarlo a través de esta revisión bibliográfica. Materiales y métodos. Se han revisado sistemáticamente las referencias sobre asistencia telefónica a enfermedades neurológicas accesibles a través de las plataformas PubMed, Embase y Cochrane, sin fecha de inicio y hasta el 3 de abril de 2022. Se encontraron 618 referencias, de las que 219 no pasaron los criterios de exclusión, por lo que se revisaron 399. Resultados. Hay un aumento de publicaciones en los últimos años y, aunque la demencia no es la enfermedad más prevalente, es el área de la neurología con más publicaciones sobre asistencia telefónica. Le siguen los ictus, el traumatismo craneoencefálico, la esclerosis múltiple, la enfermedad de Parkinson y trastornos del movimiento, la epilepsia, las enfermedades neuromusculares y otras. Discusión y conclusiones. Las demencias son las enfermedades con más referencias bibliográficas sobre su asistencia telefónica a pesar de no ser las más prevalentes. Con frecuencia, el teléfono se utiliza para administrar escalas diagnósticas o apoyar a los cuidadores, y es especialmente útil en enfermedades que dificultan la movilidad y acudir presencialmente.

Phases in the decision to request euthanasia and brain structures involved. / Fases en la decisión de solicitar la eutanasia y estructuras cerebrales involucradas.

INTRODUCTION: Euthanasia laws do not mention as an obstacle brain diseases other than dementia that damage circuits involved in decision-making. DEVELOPMENT: Narrative review of the stages of the decision to request euthanasia and the brain areas involved. The amygdala, the cingulate and insular cortex, and different parts of the prefrontal lobes are activated during decisions with similarities to that of requesting euthanasia. CONCLUSIONS: When an injury or malfunction of any of the structures involved in making decisions is known, a specific evaluation should be made of the influence it may have on the competence of the patient to request euthanasia.

TITLE: Fases en la decisión de solicitar la eutanasia y estructuras cerebrales involucradas.Introducción. Las leyes de eutanasia no mencionan como obstáculo las enfermedades cerebrales diferentes de la demencia, pero que dañan los circuitos involucrados en la toma de decisiones. Desarrollo. Revisión narrativa de las etapas de la decisión de solicitar la eutanasia y las áreas cerebrales involucradas. La amígdala, la corteza cingulada, la ínsula y distintas partes de los lóbulos prefrontales se activan durante decisiones con similitudes a la de solicitar la eutanasia. Conclusiones. Cuando se conoce una lesión o mal funcionamiento de alguna de las estructuras involucradas en la toma de decisiones, se debe realizar una evaluación específica de la influencia que pueda tener en la competencia del paciente para solicitar la eutanasia.

Fases en la decisión de solicitar la eutanasia y estructuras cerebrales involucradas / Phases in the decision to request euthanasia and brain structures involved

Introducción: Las leyes de eutanasia no mencionan como obstáculo las enfermedades cerebrales diferentes de la demencia, pero que dañan los circuitos involucrados en la toma de decisiones. Desarrollo: Revisión narrativa de las etapas de la decisión de solicitar la eutanasia y las áreas cerebrales involucradas. La amígdala, la corteza cingulada, la ínsula y distintas partes de los lóbulos prefrontales se activan durante decisiones con similitudes a la de solicitar la eutanasia. Conclusiones: Cuando se conoce una lesión o mal funcionamiento de alguna de las estructuras involucradas en la toma de decisiones, se debe realizar una evaluación específica de la influencia que pueda tener en la competencia del paciente para solicitar la eutanasia.(AU)

Introduction: Euthanasia laws do not mention as an obstacle brain diseases other than dementia that damage circuits involved in decision-making. Development: Narrative review of the stages of the decision to request euthanasia and the brain areas involved. The amygdala, the cingulate and insular cortex, and different parts of the prefrontal lobes are activated during decisions with similarities to that of requesting euthanasia. Conclusions: When an injury or malfunction of any of the structures involved in making decisions is known, a specific evaluation should be made of the influence it may have on the competence of the patient to request euthanasia.(AU)

Euthanasia and assisted suicide in neurological diseases: a systematic review. / Eutanasia y suicidio asistido en enfermedades neurológicas: una revisión sistemática.

OBJECTIVE: To identify the neurological diseases for which euthanasia and assisted suicide are most frequently requested in the countries where these medical procedures are legal and the specific characteristics of euthanasia in some of these diseases, and to show the evolution of euthanasia figures. METHODS: We conducted a systematic literature review. RESULTS: Dementia, motor neuron disease, multiple sclerosis, and Parkinson's disease are the neurological diseases that most frequently motivate requests for euthanasia or assisted suicide. Claims related to dementia constitute the largest group, are growing, and raise additional ethical and legal issues due to these patients' diminished decision-making capacity. In some countries, the ratios of euthanasia requests to all cases of multiple sclerosis, motor neuron disease, or Huntington disease are higher than for any other disease. CONCLUSIONS: After cancer, neurological diseases are the most frequent reason for requesting euthanasia or assisted suicide.

Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.

Stroke as a complication and prognostic factor of COVID-19. / Ictus como complicación y como factor pronóstico de COVID-19.

INTRODUCTION: Contradictory data have been reported on the incidence of stroke in patients with COVID-19 and the risk of SARS-CoV-2 infection among patients with history of stroke. METHODS: This study systematically reviews case series reporting stroke as a complication of COVID-19, and analyses the prognosis of patients with COVID-19 and history of stroke. The pathophysiological mechanisms of stroke in patients with COVID-19 are also reviewed. CONCLUSIONS: History of stroke increases the risk of death due to COVID-19 by 3 times. Stroke currently seems not to be one of the main complications of COVID-19.

[Validation study of the Spanish version of the Fahn-Tolosa-Marin scale for essential tremor]. / Estudio de validacion de la version española de la escala Fahn-Tolosa-Marin para el temblor esencial.

INTRODUCTION: The Fahn-Tolosa-Marin (FTM) tremor rating scale has been widely used in clinics for the estimation of tremor severity. However, a Spanish language version of this scale has still not been formally validated. AIM: To provide support to the validity and reliability of this version of FTM Scale. PATIENTS AND METHODS: A cross-sectional study was conducted on essential tremor patients. Severity was rated using the FTM scale. Upper limb disability was evaluated by terms of Disabilities of the Arm, Shoulder and Hand Scale (DASH), and to health-related quality of life using the Short Form-36 Health Survey (SF-36). Statistical analysis included sample description, reliability (Cronbach's alpha), convergent validity, and discrimination capacity tests (ROC curves). RESULTS: Forty patients with essential tremor (22 women, 18 men) were included, with a mean age of 65.8 ± 14.7 years (range: 21-90 years). Internal consistency of the FTM was high: Cronbach's alpha: 0,90 (subscale A: 0.85; subscale B: 0.91; subscale C: 0.77), and the floor and ceiling effects were negligible. The FTM (subscale C) showed high correlations with DASH, and acceptable diagnostic capacity, with an area under the curve of 0.86 (95% CI: 0.67-1.00), sensitivity 78% and specificity 75% for a cut-off score > 5.5. CONCLUSION: The Spanish version of FTM the rating scale is a reliable and valid tool to evaluate disability in patients with essential tremor, and a suitable instrument for use in medical research, as well as in clinical practice.

TITLE: Estudio de validacion de la version española de la escala Fahn-Tolosa-Marin para el temblor esencial.Introduccion. Hasta ahora no existe una validacion formal de la version española de la escala Fahn-Tolosa-Marin (FTM), usada ampliamente para valorar la gravedad del temblor. Objetivo. Analizar la validez y la fiabilidad de la version en castellano de la escala FTM. Pacientes y metodos. Estudio observacional transversal en pacientes diagnosticados de temblor esencial. Se evaluo la gravedad del temblor con la escala FTM; la discapacidad en el miembro superior, con la escala Disabilities of the Arm, Shoulder and Hand (DASH), y la calidad de vida relacionada con la salud, con el cuestionario Short Form-36 Health Survey (SF-36). El analisis estadistico incluyo descripcion de la muestra, fiabilidad (alfa de Cronbach), validez convergente y capacidad discriminatoria (curvas ROC). Resultados. Se incluyo a 40 pacientes (22 mujeres y 18 hombres con temblor esencial), con una edad media de 65,8 ± 14,7 años (rango: 21-90 años). La fiabilidad de la FTM fue alta, con un alfa de Cronbach de 0,90 (subescala A: 0,85; subescala B: 0,91; subescala C: 0,77). Para evaluar la discapacidad originada por el temblor esencial, la validez convergente entre las escalas DAHS y FTM (subescala C) fue adecuada, con una capacidad diagnostica aceptable: area bajo la curva de 0,86 (intervalo de confianza al 95%: 0,67-1,00), sensibilidad del 78% y especificidad del 75%, para un punto de corte mayor de 5,5. Conclusion. La escala FTM es un instrumento fiable, valido y preciso para la valoracion del temblor esencial en la poblacion española adulta.

[Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]. / Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.

INTRODUCTION: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. AIM: To analyze and summarize different questions about the use of BTA in our clinical practice. DEVELOPMENT: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. CONCLUSION: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.Introduccion. La toxina botulinica de tipo A (TBA) ha supuesto una verdadera revolucion terapeutica en neurologia, y en la actualidad es el tratamiento rutinario en las distonias focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relacion con la neurofarmacologia de la TBA y su uso en las distonias en la practica clinica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento reviso una lista de temas controvertidos relacionados con la farmacologia de la TBA y su uso en las distonias. Revisamos la bibliografia e incluimos articulos relevantes especialmente en ingles, pero tambien, si su importancia lo merece, en castellano y en frances, hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacologia, especialmente el mecanismo de accion, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relacion con el subapartado de las distonias, se incluyeron aspectos sobre la evaluacion y el tratamiento de las distonias focales. Conclusiones. Esta revision no pretende ser una guia, sino una herramienta practica destinada a neurologos y medicos internos residentes interesados en esta area, dentro de diferentes ambitos especificos del manejo de la TBA.

Odours in sewer networks: nuisance assessment.

As odour nuisance can affect the quality of life, the population is more and more demanding and in many cities sewers are a critical source of odours. Both factors can lead to increasing numbers of complaints due to the odour nuisance perceived by the residents, affecting also the public image of the sewer management companies. Odours associated with sewer networks are very heterogeneous, in as much as the different 'types of odours' encountered are sewer site specific. The state of the art indicates that there are three parameters that play an important role with the nuisance generated by an odour: hedonic odour tone, odour concentration and odour intensity. This paper presents the results of the study on odour nuisance carried out in different points of the sewer network, with the aim to assess the nuisance generated and identify which points of the sewer should be targeted to implement corrective actions. Considering the different parameters assessed, pumping stations have been identified as critical points of odour nuisance in the sewers, being recommended to implement an odour treatment system in order to guarantee the odour comfort of residents.

Assessment of odour and H(2)S impact in WWTPs by cryo-condensation.

Stability of gaseous samples is a major concern when dealing with odours and airborne pollutants sampling. In terms of odours, the representativeness of the sample can be very seriously compromised, despite the rigorous application of the maximum storage time established by EN-13725. The present paper is focused on the use of the cryo-condensation technique (Cryocore) for time-weighted-average (TWA) sampling in waste water treatment plants (WWTPs), with the aim of comparing the values of TWA odour and H(2)S concentration when using the Cryocore system and other well established sampling methods, such as those described in EN-13725 and passive sampling. The study showed comparable results when comparing all the methodologies tested.