Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke. / Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo.

INTRODUCTION: Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective). PATIENTS AND METHODS: The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups. RESULTS: Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262). CONCLUSIONS: Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.

TITLE: Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo.Introducción. La apnea obstructiva del sueño (AOS) se ha propuesto como un factor de mal pronóstico en el ictus. Pretendemos determinar si una intervención sobre la AOS puede mejorar las escalas de calidad de vida (primer objetivo) y de discapacidad (segundo objetivo). Pacientes y métodos. El grupo de intervención de este estudio cuasi experimental incluye a pacientes con ictus isquémico agudo menor de 72 horas de evolución a quienes se les realizó poligrafía, así como presión positiva continua en las vías aéreas (CPAP) y medidas higienicodietéticas si se requerían. En el grupo de control se siguió la práctica clínica habitual. Se aplicaron las escalas Short Form 36 Health Survey (SF-36) y modified Rankin Score (mRS) en el sexto mes del ictus en ambos grupos. Resultados. Se incluyó a 55 y a 62 pacientes en el grupo de intervención y en el de control, respectivamente. En el grupo de intervención, el 64,71% de los pacientes aceptó la CPAP indicada (16 casos con buena adhesión). Se detectó una mejoría en los ítems de la escala SF-36 en el grupo de intervención: funcionamiento físico (p = 0,008), rol físico (p = 0,002), dolor corporal (p = 0,008), salud general (p menor de 0,001), vitalidad (p = 0,001) y rol emocional (p = 0,015). En un análisis por protocolo, todas estas mejorías se comprobaron en el grupo de pacientes tratados con CPAP con buena adhesión (p menor de 0,05 en todos los ítems de la SF-36). El porcentaje de pacientes con el sumatorio del componente físico = 50 fue más alto en el grupo de intervención (p = 0,003). No había diferencias en la mediana de la mRS (p = 0,262). Conclusiones. Aunque se necesitan más evidencias, nuestro estudio sugiere una mejoría significativa de la calidad de vida tras nuestra intervención en la AOS, especialmente en pacientes con buena adhesión a la CPAP.

Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo / Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke

Introducción: La apnea obstructiva del sueño (AOS) se ha propuesto como un factor de mal pronóstico en el ictus. Pretendemos determinar si una intervención sobre la AOS puede mejorar las escalas de calidad de vida (primer objetivo) y de discapacidad (segundo objetivo). Pacientes y métodos: El grupo de intervención de este estudio cuasi experimental incluye a pacientes con ictus isquémico agudo < 72 horas de evolución a quienes se les realizó poligrafía, así como presión positiva continua en las vías aéreas (CPAP) y medidas higienicodietéticas si se requerían. En el grupo de control se siguió la práctica clínica habitual. Se aplicaron las escalas Short Form 36 Health Survey (SF-36) y modified Rankin Score (mRS) en el sexto mes del ictus en ambos grupos. Resultados: Se incluyó a 55 y a 62 pacientes en el grupo de intervención y en el de control, respectivamente. En el grupo de intervención, el 64,71% de los pacientes aceptó la CPAP indicada (16 casos con buena adhesión). Se detectó una mejoría en los ítems de la escala SF-36 en el grupo de intervención: funcionamiento físico (p = 0,008), rol físico (p = 0,002), dolor corporal (p = 0,008), salud general (p < 0,001), vitalidad (p = 0,001) y rol emocional (p = 0,015). En un análisis por protocolo, todas estas mejorías se comprobaron en el grupo de pacientes tratados con CPAP con buena adhesión (p < 0,05 en todos los ítems de la SF-36). El porcentaje de pacientes con el sumatorio del componente físico = 50 fue más alto en el grupo de intervención (p = 0,003). No había diferencias en la mediana de la mRS (p = 0,262). Conclusiones: Aunque se necesitan más evidencias, nuestro estudio sugiere una mejoría significativa de la calidad de vida tras nuestra intervención en la AOS, especialmente en pacientes con buena adhesión a la CPAP.

Introduction: Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective). Patients and methods: The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups. Results: Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory ≥ 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262). Conclusions: Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.(AU)

Vericiguat en insuficiencia cardíaca: de la evidencia científica a la práctica clínica / Vericiguat in heart failure: from scientific evidence to clinical practice

A pesar de los tratamientos actuales, el riesgo de muerte y hospitalizaciones en pacientes con insuficiencia cardíaca con fracción de eyección reducida (IC-FEr) sigue siendo elevado. La fisiopatología de la IC-FEr incluye activación neurohormonal caracterizada por la estimulación de las vías deletéreas (sistemas simpático y renina-angiotensina-aldosterona) y la supresión de las vías protectoras como las dependientes del óxido nítrico. La inhibición o estimulación de algunas de estas vías, pero no de todas, es insuficiente. En la IC-FEr existe una menor actividad de óxido nítrico, guanilato ciclasa soluble y GMPc que provoca efectos deletéreos a nivel miocárdico, vascular y renal. Vericiguat estimula la actividad de esta vía protectora. El estudio VICTORIA demostró, en pacientes con IC-FEr y descompensación reciente, que la adición de vericiguat al tratamiento médico óptimo reducía de forma significativa la incidencia del objetivo primario compuesto de muerte cardiovascular u hospitalización por IC, con un número de 24 pacientes que es necesario tratar, y una excelente tolerabilidad (AU)

Despite currently available treatments, risk of death and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) remains high. The pathophysiology of HFrEF includes neurohormonal activation characterized by stimulation of deleterious pathways (i.e., sympathetic nervous and renin-angiotensin-aldosterone systems) and suppression of protective pathways such as nitric oxide-dependent pathways. Inhibition or stimulation of some, but not all, of these pathways is insufficient. In HFrEF, there is reduced nitric oxide, soluble guanylate cyclase, and cGMP activity, leading to deleterious effects in the myocardial, vascular, and renal systems. Vericiguat is able to stimulate the activity of this protective pathway. The VICTORIA study demonstrated that the addition of vericiguat to optimal medical treatment in patients with HFrEF and recent decompensation significantly reduced the incidence of the primary endpoint, a composite of cardiovascular death or HF hospitalization, with a number needed to treat of 24 patients and excellent tolerability (AU)

Vericiguat in heart failure: From scientific evidence to clinical practice.

Despite currently available treatments, risk of death and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) remains high. The pathophysiology of HFrEF includes neurohormonal activation characterized by stimulation of deleterious pathways (i.e., sympathetic nervous and renin-angiotensin-aldosterone systems) and suppression of protective pathways such as nitric oxide-dependent pathways. Inhibition or stimulation of some, but not all, of these pathways is insufficient. In HFrEF, there is reduced nitric oxide, soluble guanylate cyclase, and cGMP activity, leading to deleterious effects in the myocardial, vascular, and renal systems. Vericiguat is able to stimulate the activity of this protective pathway. The VICTORIA study demonstrated that the addition of vericiguat to optimal medical treatment in patients with HFrEF and recent decompensation significantly reduced the incidence of the primary endpoint, a composite of cardiovascular death or HF hospitalization, with a number needed to treat of 24 patients and excellent tolerability.

Incremento matutino de la presión arterial en pacientes con ictus isquémico reciente: el factor olvidado / Morning blood pressure surge in patients with recent ischaemic stroke: the neglected factor

Introducción: Un incremento matutino de presión arterial (IMPA) elevado se asocia con la aparición de eventos cardiovasculares. Evaluamos la presencia de un IMPA elevado en pacientes con ictus isquémico reciente. Material y métodos: Se realizó un estudio casos-control. Se incluyeron 100 pacientes con un ictus isquémico en los 6 meses previos y 50 pacientes hipertensos sin enfermedad cardiovascular como controles. Resultados: Se estudiaron 61 ictus lacunares (LAC) y 39 no lacunares (NLAC). La edad media fue de 65±11 años, y 60 (40%) pacientes eran mujeres. El IMPA elevado estaba presente en el 9% de los ictus (en 5 LAC y 4 NLAC) y en el 8% de los controles (p no significativa [NS]), con un valor medio similar de IMPA en ambos grupos: 23,9±14mmHg y 24,9±15mmHg respectivamente (p=NS), aunque los pacientes controles presentaron una PA más alta en consulta (sistólica [p=0,008] y diastólica [p=0,0001]), PA sistólica de 24h (p=0,028) y PA sistólica diurna (p=0,022). Entre los pacientes con ictus, un IMPA elevado se asoció con enfermedad coronaria previa (p=0,005), con el patrón circadiano de PA (p=0,029), pero no con el tratamiento antihipertensivo prescrito. En el análisis multivariante, el IMPA elevado solo se asoció con enfermedad coronaria previa (p=0,001). Conclusiones: Aproximadamente uno de cada 10 pacientes con ictus isquémico reciente presenta un IMPA elevado. Se deberían implementar estrategias para la detección y tratamiento del IMPA tras un ictus.

Introduction: High morning BP surge (MBPS) has been associated with an increased risk of cardiovascular events. We evaluated the presence of a high MBPS in patients with recent ischaemic stroke. Material and methods: A case-control study was carried out. One hundred patients with an ischaemic stroke in the previous 6 months and fifty hypertensive patients without cardiovascular disease were included as controls. Results: 61 lacunar (LAC) and 39 non-lacunar (NLAC) strokes were studied. The mean age was 65±11 years, and 60 (40%) patients were women. High MBPS was present in 9% of strokes (in 5 LAC and 4 NLAC) and in 8% of controls (p not significant [NS]), with a similar mean value of MBPS in both groups: 23.9±14mmHg and 24.9±15mmHg respectively (p=NS), although the control patients had a higher office BP (systolic [p=.008] and diastolic [p=.0001]), 24h systolic BP (p=.028) and daytime systolic BP (p=.022). Among the stroke patients, high MBPS was associated with previous coronary heart disease (p=.005), circadian BP pattern (p=.029), but not with the type of antihypertensive treatment prescribed. In multivariate analysis, elevated MBPS was only associated with previous coronary artery disease (p=.001). Conclusions: Approximately one in ten patients with recent ischaemic stroke has a high MBPS. Strategies to detect and treat high MBPS after a stroke are needed.

[Morning blood pressure surge in patients with recent ischaemic stroke: the neglected factor]. / Incremento matutino de la presión arterial en pacientes con ictus isquémico reciente: el factor olvidado.

INTRODUCTION: High morning BP surge (MBPS) has been associated with an increased risk of cardiovascular events. We evaluated the presence of a high MBPS in patients with recent ischaemic stroke. MATERIAL AND METHODS: A case-control study was carried out. One hundred patients with an ischaemic stroke in the previous 6 months and fifty hypertensive patients without cardiovascular disease were included as controls. RESULTS: 61 lacunar (LAC) and 39 non-lacunar (NLAC) strokes were studied. The mean age was 65±11 years, and 60 (40%) patients were women. High MBPS was present in 9% of strokes (in 5 LAC and 4 NLAC) and in 8% of controls (p not significant [NS]), with a similar mean value of MBPS in both groups: 23.9±14mmHg and 24.9±15mmHg respectively (p=NS), although the control patients had a higher office BP (systolic [p=.008] and diastolic [p=.0001]), 24h systolic BP (p=.028) and daytime systolic BP (p=.022). Among the stroke patients, high MBPS was associated with previous coronary heart disease (p=.005), circadian BP pattern (p=.029), but not with the type of antihypertensive treatment prescribed. In multivariate analysis, elevated MBPS was only associated with previous coronary artery disease (p=.001). CONCLUSIONS: Approximately one in ten patients with recent ischaemic stroke has a high MBPS. Strategies to detect and treat high MBPS after a stroke are needed.

[Hyperlipoproteinaemia(a) and stroke. A case report of a family with early-onset severe atherosclerotic disease]. / Hiperlipoproteinemia(a) e ictus. A propósito de una familia con enfermedad ateroesclerótica grave precoz.

TITLE: Hiperlipoproteinemia(a) e ictus. A propósito de una familia con enfermedad ateroesclerótica grave precoz.

Lesión fibrótica en cicatriz de mastectomía: ¿estamos ante una recidiva? / Fibrotic lesion in a mastectomy scar: is this a recurrence?

El uso de la radioterapia para el cáncer de mama ha mejorado sustancialmente las tasas de supervivencia para esta enfermedad1;sin embargo, una consecuencia de esto son las complicaciones inducidas por el tratamiento en pacientes que cada vez son máslongevas. Décadas después de la irradiación de la pared torácica, puede desarrollarse una osteomielitis inducida por la radiaciónde inicio muy tardío, causada por osteorradionecrosis2. Es una complicación sumamente infrecuente pero descrita en la literatura. (AU)

The use of radiation therapy for breast cancer has substantially improved survival rates for this disease1; however, one consequenceof this is treatment-induced complications in patients who are increasingly living longer. Decades after chest wall irradiation, verylate-onset radiation-induced osteomyelitis, caused by osteoradionecrosis, can develop2. This is a very rare but a described complication in the literature. (AU)

[Delayed administration of thrombolytic therapy in minor stroke]. / Retraso en la administración de tratamiento trombolítico en el ictus minor.

INTRODUCTION: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. PATIENTS AND METHODS: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. RESULTS: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. CONCLUSIONS: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.

TITLE: Retraso en la administración de tratamiento trombolítico en el ictus minor.Introducción. Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados. Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones. La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.

Retraso en la administración de tratamiento trombolítico en el ictus minor / Delayed administration of thrombolytic therapy in minor stroke

Introducción: Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados: Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones: La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.(AU)

Introduction: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. Patients and methods: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. Results: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. Conclusions: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.(AU)

Utilidad de la ecografía de nervio óptico como predictor de progresión en esclerosis múltiple / Usefulness of optic nerve ultrasound to predict clinical progression in multiple sclerosis

Introducción: La pérdida neuronal/axonal progresiva se considera la causa más importante de discapacidad neurológica en la esclerosis múltiple (EM). El sistema visual está frecuentemente afectado en esta enfermedad y su accesibilidad a test funcionales y estructurales ha permitido que se convierta en un modelo para estudiar in vivo la patogenia de la EM. La ecografía orbitaria permite evaluar, de forma no invasiva y en tiempo real, las diversas estructuras de la órbita, incluido el nervio óptico.Material y métodosSe ha llevado a cabo un estudio observacional ambispectivo en pacientes con EM recogiéndose datos evolutivos de la enfermedad. La ecografía orbitaria se realizó en todos los pacientes según el principio de mínima potencia necesaria (ALARA). También se recogieron los datos de tomografía de coherencia óptica (OCT) en aquellos que tenían realizadas ambas pruebas. El estudio estadístico se efectuó con el programa SPSS 22.0.ResultadosSe encontraron correlaciones estadísticamente significativas entre las medidas ecográficas y la progresión de la enfermedad (p = 0,041 para el ojo derecho y p = 0,037 para el ojo izquierdo), y la Expanded Disability Status Scale (EDSS) final en el seguimiento (p = 0,07 para el ojo derecho y p = 0,043 para el ojo izquierdo). No fue así para los datos referentes a brotes y a otras variables clínicas.DiscusiónLa medición del diámetro del nervio óptico por ecografía podría utilizarse como medida predictiva en la evolución de la EM, ya que la disminución del mismo se asocia con progresión clínica y mayor discapacidad, medidas con la EDSS. (AU)

Introduction: Progressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time.Material and methodsWe conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the ‘as low as reasonably achievable’ (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0.ResultsDisease progression was significantly correlated with ultrasound findings (P = .041 for the right eye and P = .037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P = .07 for the right eye and P = .043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables.DiscussionUltrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS). (AU)

Gestión de la comunicación de los pacientes hospitalizados, aislados con sus familias por la COVID-19 / Management of communication between inpatients isolated due to COVID-19 and their families

ANTECEDENTES Y OBJETIVO: La calidad asistencial se ha podido ver afectada por las dimensiones de la pandemia de COVID-19 y el estricto aislamiento hospitalario al que han sido sometidos los pacientes. Por ello, se plantea describir el proceso diseñado para facilitar la comunicación de los pacientes aislados con sus familias, detectar sus necesidades y realizar intervenciones individualizadas. MÉTODO: Estudio cualitativo con metodología de investigación acción, respondiendo al siguiente algoritmo: planificar la acción, diagnóstico de la necesidad e hipótesis-acción; aplicar la acción, creación del grupo de gestores de casos y formación de los miembros; observar la acción, recoger y analizar la información. Durante el mes de abril del 2020. RESULTADOS: Se realizaron 1.754 interacciones que afectaron a 490 pacientes. Los gestores de casos realizaron 767 llamadas dirigidas principalmente a facilitar información sobre el ingreso (71,45%) y cambios de ubicación o funcionamiento de las unidades (18,84%). Recibieron un total de 1.098 llamadas de familiares solicitando: información médica (43,8%), comunicación con los pacientes (18,48%), entrega de enseres personales o gestión de objetos extraviados (12,84%) e información sobre la ubicación del paciente o gestión del alta (10,20%). En el 66% de los casos las llamadas fueron resueltas por los gestores, el 30% fueron derivadas y el 4% fallidas. CONCLUSIONES: La puesta en funcionamiento del grupo de gestores de casos ha contribuido a mejorar la comunicación de los pacientes ingresados y aislados por COVID-19 con sus familias, dando respuesta a las necesidades planteadas, mejorando la calidad asistencial y favoreciendo la humanización en los cuidados

BACKGROUND AND GOAL: Quality of healthcare has been affected by the current dimensions of the COVID-19 pandemic and the strict hospital isolation to which some inpatients have been subjected. Therefore, we propose to describe the process designed to facilitate the communication of inpatients with their families to detect their needs and perform individualized treatments in each case. METHOD: Qualitative study with action research methodology, responding to the following algorithm: plan the action, diagnosis of the need and hypothesis-action; apply the action, creation of the group of case managers and training of the members; observe the action, collect and analyse the information. During the month of April 2020. RESULTS: 1,754 interactions were undertaken, that affected 490 inpatients. Case Managers made 767 calls, to provide information about admissions (71.45%), changes in inpatient location or operation of units (18.84%), among others. One thousand and ninety-eight calls from family members were received requesting medical information (43.8%), to talk to inpatients (18.48%), to deliver personal articles or manage lost objects (12.84%), and seeking information about patient location or medical discharge (10.20%). Sixty-six percent of the requests were solved by Case Managers, 30% were referred on and 4% could not be solved. CONCLUSIONS: Implementation of the Case Manager Group contributed to encourage communication of inpatients isolated due to COVID-19 with their families, responding to needs raised, improving quality of care and promoting humanization of care

[Management of communication between inpatients isolated due to COVID-19 and their families]. / Gestión de la comunicación de los pacientes hospitalizados, aislados con sus familias por la COVID-19.

BACKGROUND AND GOAL: Quality of healthcare has been affected by the current dimensions of the COVID-19 pandemic and the strict hospital isolation to which some inpatients have been subjected. Therefore, we propose to describe the process designed to facilitate the communication of inpatients with their families to detect their needs and perform individualized treatments in each case. METHOD: Qualitative study with action research methodology, responding to the following algorithm: plan the action, diagnosis of the need and hypothesis-action; apply the action, creation of the group of case managers and training of the members; observe the action, collect and analyse the information. During the month of April 2020. RESULTS: 1,754 interactions were undertaken, that affected 490 inpatients. Case Managers made 767 calls, to provide information about admissions (71.45%), changes in inpatient location or operation of units (18.84%), among others. One thousand and ninety-eight calls from family members were received requesting medical information (43.8%), to talk to inpatients (18.48%), to deliver personal articles or manage lost objects (12.84%), and seeking information about patient location or medical discharge (10.20%). Sixty-six percent of the requests were solved by Case Managers, 30% were referred on and 4% could not be solved. CONCLUSIONS: Implementation of the Case Manager Group contributed to encourage communication of inpatients isolated due to COVID-19 with their families, responding to needs raised, improving quality of care and promoting humanization of care.

Usefulness of optic nerve ultrasound to predict clinical progression in multiple sclerosis. / Utilidad de la ecografía de nervio óptico como predictor de progresión en esclerosis múltiple.

INTRODUCTION: Progressive neuronal and axonal loss are considered the main causes of disability in patients with multiple sclerosis (MS). The disease frequently involves the visual system; the accessibility of the system for several functional and structural tests has made it a model for the in vivo study of MS pathogenesis. Orbital ultrasound is a non-invasive technique that enables various structures of the orbit, including the optic nerve, to be evaluated in real time. MATERIAL AND METHODS: We conducted an observational, ambispective study of MS patients. Disease progression data were collected. Orbital ultrasound was performed on all patients, with power set according to the 'as low as reasonably achievable' (ALARA) principle. Optical coherence tomography (OCT) data were also collected for those patients who underwent the procedure. Statistical analysis was conducted using SPSS version 22.0. RESULTS: Disease progression was significantly correlated with ultrasound findings (P=.041 for the right eye and P=.037 for the left eye) and with Expanded Disability Status Scale (EDSS) score at the end of the follow-up period (P=.07 for the right eye and P=.043 for the left eye). No statistically significant differences were found with relation to relapses or other clinical variables. DISCUSSION: Ultrasound measurement of optic nerve diameter constitutes a useful, predictive factor for the evaluation of patients with MS. Smaller diameters are associated with poor clinical progression and greater disability (measured by EDSS).

The Chemistry of Cosmic Dust Analogues from C, C2, and C2H2 in C-Rich Circumstellar Envelopes.

Interstellar carbonaceous dust is mainly formed in the innermost regions of circumstellar envelopes around carbon-rich asymptotic giant branch (AGB) stars. In these highly chemically stratified regions, atomic and diatomic carbon, along with acetylene are the most abundant species after H2 and CO. In a previous study, we addressed the chemistry of carbon (C and C2) with H2 showing that acetylene and aliphatic species form efficiently in the dust formation region of carbon-rich AGBs whereas aromatics do not. Still, acetylene is known to be a key ingredient in the formation of linear polyacetylenic chains, benzene and polycyclic aromatic hydrocarbons (PAHs), as shown by previous experiments. However, these experiments have not considered the chemistry of carbon (C and C2) with C2H2. In this work, by employing a sufficient amount of acetylene, we investigate its gas-phase interaction with atomic and diatomic carbon. We show that the chemistry involved produces linear polyacetylenic chains, benzene and other PAHs, which are observed with high abundances in the early evolutionary phase of planetary nebulae. More importantly, we have found a non-negligible amount of pure and hydrogenated carbon clusters as well as aromatics with aliphatic substitutions, both being a direct consequence of the addition of atomic carbon. The incorporation of alkyl substituents into aromatics can be rationalized by a mechanism involving hydrogen abstraction followed by methyl addition. All the species detected in gas phase are incorporated into the nanometric sized dust analogues, which consist of a complex mixture of sp, sp2 and sp3 hydrocarbons with amorphous morphology.

Primoinfección por citomegalovirus en un paciente con esclerosis múltiple recurrente-remitente tratado con alemtuzumab / Primary cytomegalovirus infection in a patient with relapsing-remitting multiple sclerosis under treatment with alemtuzumab

No disponible

Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery.

Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.

Electrochemical Synthesis and Magnetic Properties of MFe2O4 (M = Fe, Mn, Co, Ni) Nanoparticles for Potential Biomedical Applications.

In this study, we evaluate the magnetic properties and cytotoxic effect of magnetic nanoparticles (MNPs) based on magnetite and Mn, Co and Ni ferrites, obtained by electrochemical synthesis. These nanoparticles have almost spherical shape and an mode size of 9±1 nm. The electrochemical synthesis produces a single crystallographic phase with a spinel-like structure in all cases. Magnetization saturation at room temperature varies with the composition of the ferrites from MS (Fe3O4) > MS (MnFe2O4) > MS (CoFe2O4) > MS (NiFe2O4). Ferrite MNPs present low magnetic remanence indicating a superparamagnetic-like response at room temperature. However, the different values of magnetic anisotropy and size produce variations in the values of coercivity and susceptibility of the ferrite MNPs. The cytotoxicity of the different ferrites was evaluated by internalizing MNP in HeLa cancer cells. Although magnetite and Mn ferrite present low toxicity for all the concentrations studied, significant cytotoxic effect were observed when incubating the cells with high concentration of Co and Ni ferrites.