ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

[Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemia: A rapid review & consensus of experts]. / Recomendaciones éticas para la toma de decisiones difíciles en las unidades de cuidados intensivos ante la situación excepcional de crisis por la pandemia por COVID-19: revisión rápida y consenso de expertos.

In view of the exceptional public health situation caused by the COVID-19 pandemic, a consensus work has been promoted from the ethics group of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), with the objective of finding some answers from ethics to the crossroads between the increase of people with intensive care needs and the effective availability of means.In a very short period, the medical practice framework has been changed to a 'catastrophe medicine' scenario, with the consequent change in the decision-making parameters. In this context, the allocation of resources or the prioritization of treatment become crucial elements, and it is important to have an ethical reference framework to be able to make the necessary clinical decisions. For this, a process of narrative review of the evidence has been carried out, followed by a unsystematic consensus of experts, which has resulted in both the publication of a position paper and recommendations from SEMICYUC itself, and the consensus between 18 scientific societies and 5 institutes/chairs of bioethics and palliative care of a framework document of reference for general ethical recommendations in this context of crisis.

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. / Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

¿Se debe restringir el ingreso en cuidados intensivos solo a los pacientes más graves? / Should intensive care admission be restricted to the most severely ill patients?

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Dependency relationships among ear characters in a Spanish sample, its forensic interest.

The aim of this paper is to provide information on dependency relationships between the morphological characters of the external ear and their importance in physical identification. At present, there is a lack of population data in this field, and little research has been published. Our study sample consisted of 281 Spanish university students of European descent aged between 18 and 31 years old. We analysed a total of 562 ears. For a large number of characters, we found a dependency between anatomically related characters, confirming our hypothesis. For example, we found relationships between ear shape and protrusion, between rolling of the superior and posterior helix, and between the upper and lower parts of the scapha. However, our results also indicated that some anatomically related characters did not present relationships. Thus, we found no dependency between contour shape of the supero-posterior helix and rolling of the posterior helix or between intertragic incisure shape and tragus or antitragus shape. In addition, we found that some characters that are not anatomically related also showed relationships. These included rolling of the superior helix and intertragic incisure shape, and contour shape of the superior helix and the inferior part of the scapha. These results are of great importance and should be taken into account in forensic applications.

Morphological variability of the earlobe in a Spanish population sample.

This article shows the morphological variability of the earlobe in a Spanish population of European origin. The frequencies of four lobe characteristics (attachment, contour, modeling, and size) and their degree of expression were studied. The relationship among the characteristics and the differences involving sex and laterality were also considered. The least frequent morphology, and of main use in solving forensic cases, was the very small size with triangle-pulled contour into the skin and crossed-discontinuous modeling. The most frequent morphology, and most clinically useful, was the medium-sized lobe with free-arched contour and eminent or cross-continuous modeling. The characteristics were all symmetric. Size and modeling showed sexual dimorphism. Some characteristics were associated with each other: attachment with contour and modeling and the contour with modeling and size. The least frequent peculiarities were sharp lobe and virgule. The literature is scarce on this matter, practically non-existent for some characteristics, especially modeling and peculiarities. For the first time, the associations of the ear characteristics were analyzed, and this information could be applied to forensic identification.

Pacientes críticos al final de la vida: estudio multicéntrico en Unidades de Cuidados Intensivos españolas / End of life critical patients: A multicenter study in Spanish Intensive Care Units

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Anthropological study of ear tubercles in a Spanish sample.

The ear has been used since the 19th century as a valuable instrument in personal identification. Its special interest is due to the morphological complexity of the structures involved. The aim of the present investigation is to establish the morphological variability of the helix tubercles in a sample of the Spanish European population (303 individuals between 18 and 72 years old). The frequencies of appearance of each type of tubercle and its degree of expression, as well as the possible relationship with sex, age, and laterality, are determined. Three of the tubercles are relatively frequent in the sample: tubercle of the root of the superior helix (31.7%), tubercle of the anterior helix (27.6%), and the Darwin's tubercle (18.2%). The least frequent helix tubercles are those located on the superior helix (2.7%) and the inferior tubercles at the root of the helix (6%). For all sites, tubercles with the greatest degree of expression are the least frequent. No sexual dimorphism or age differences have been found except for the tubercle of the anterior helix. Overall, tubercles show good symmetry. A relation of dependency among some of the tubercles of the helix has been found.

Effects of nemorosone, isolated from the plant Clusia rosea, on the cell cycle and gene expression in MCF-7 BUS breast cancer cell lines.

BACKGROUND: Breast cancer is the cause of considerable morbidity and mortality in women. While estrogen receptor antagonists have been widely used in breast cancer treatment, patients have increasingly shown resistance to these agents and the identification of novel targeted therapies is therefore required. Nemorosone is the major constituent of the floral resin from Clusia rosea and belongs to the class of polycyclic polyisoprenylated benzophenones of the acylphloroglucinol group. The cytotoxicity of nemorosone in human cancer cell lines has been reported in recent years and has been related to estrogen receptors in breast cancer cells. METHODS: Changes induced by nemorosone in the cell cycle and gene expression of the MCF-7 BUS (estrogen-dependent) breast cancer cell line were analyzed using flow cytometry and the RT(2) Profiler PCR array, respectively. RESULTS: In comparison to breast cancer cells without treatment, nemorosone induced discrete cell cycle arrest in the G1 phase and significant depletion in the G2 phase. Moreover, the compound altered the expression of 19 genes related to different pathways, especially the cell cycle, apoptosis and hormone receptors. CONCLUSION: These promising results justify further studies to clarify mechanisms of action of nemorosone, in view of evaluate the possible use of this benzophenone as adjuvant in the treatment of breast cancer.

Criterios para limitar los tratamientos de soporte vital al ingreso en unidad de cuidados intensivos: resultados de una encuesta multicéntrica nacional / Life-sustaining treatment limitation criteria upon admission to the intensive care unit: results of a Spanish national multicenter survey

OBJETIVO: Conocer la predisposición de la limitación de tratamientos de soporte vital (LTSV) al ingreso en las unidades de cuidados intensivos (UCI), y en base a qué criterios se decide la LTSV y si estas decisiones se relacionan con factores estructurales de los hospitales encuestados. DISEÑO: Estudio descriptivo multicéntrico. En 2010 enviamos una encuesta a 90 hospitales dirigida a recoger la práctica habitual de la LTSV al ingreso. Ámbito: UCI nacionales. Intervención: Encuesta de opinión. Variables de interés principales: Tipo de titularidad del hospital, número de camas hospitalarias, de UCI y de semicríticos, disponibilidad habitual de camas de UCI, utilización de criterios restrictivos de ingreso, utilización de criterios de LTSV ya al ingreso, y tipo de criterio utilizado para decidir LTSV. RESULTADOS: Han participado 43 (48%) hospitales, en los que el ingreso de pacientes con LTSV es una práctica común (93%). La LTSV se decide mayoritariamente por: la presencia de una enfermedad crónica severa previa (95%), el respeto a las voluntades anticipadas del paciente (95%), la limitación funcional previa (85%), y la futilidad cualitativa (82%). Disponer frecuentemente de camas de UCI (77% de los hospitales) y el uso de criterios restrictivos (79% de los hospitales) también se asoció al ingreso de pacientes con LTSV. CONCLUSIONES: El ingreso en la UCI de pacientes con LTSV es una práctica que está generalizada en nuestros hospitales. La LTSV se basa en la futilidad fisiológica desde una posición médica objetiva, pero también atendiendo a implicaciones éticas y morales basadas en futilidad cualitativa

OBJECTIVE: To determine the life-sustaining treatment limitation (LSTL) predisposition upon patient admission to the intensive care unit (ICU), the criteria upon which such predisposition is based, and whether these decisions are related to structural factors of the surveyed hospitals. DESIGN: A descriptive multicenter study was made in 2010, involving the conduction of a survey in 90 hospitals, with a view to documenting the usual practice referred to LSTL upon admission in these centers. SETTING: Spanish ICUs. Intervention: Opinion survey. Main variables of interest: Type of hospital, number of hospital beds, ICU and semicritical patient beds, usual bed availability in the ICU, use of restrictive admission criteria, use of LSTL criteria upon admission, and type of criterion used to decide LSTL. Results; A total of 43 (48%) hospitals participated in the study, with LSTL being a common practice in these centers (93%). LSTL was fundamentally decided on the basis of the presence of prior severe chronic disease (95%), observation of previously declared patient will (95%), prior functional limitation (85%), and qualitative futility of care (82%). Frequent ICU bed availability (77% of the hospitals) and the use of restrictive criteria (79% of the hospitals) were also associated to patient admission with LSTL. CONCLUSIONS: Admission to ICU with LSTL is a generalized practice in Spanish Hospitals. LSTL is decided based on physiological futility from an objective medical point of view, but also in observance of ethical and moral implications based on the qualitative futility of medical care

Epidemia de enfermedad renal crónica en Centroamérica / An epidemic of chronic kidney disease in Central America: an overview

En varios países de la región centroamericana la enfermedad renal crónica se ha convertido en la primera causa de muerte en hombres jóvenes trabajadores sin antecedentes de enfermedades cardiovasculares. La falta de acceso por parte de los pacientes a terapias de sustitución renal (diálisis y/o transplante) hace que en algunas comunidades con elevada carga de enfermedad, ésta esté teniendo un alto impacto social y económico. Este editorial describe esta epidemia, recoge por primera la limitada evidencia científica hasta la fecha, explora las posibles hipótesis causales y prioriza intervenciones de salud pública necesarias a la luz de los resultados(AU)

[Life-sustaining treatment limitation criteria upon admission to the intensive care unit: results of a Spanish national multicenter survey]. / Criterios para limitar los tratamientos de soporte vital al ingreso en unidad de cuidados intensivos: resultados de una encuesta multicéntrica nacional.

OBJECTIVE: To determine the life-sustaining treatment limitation (LSTL) predisposition upon patient admission to the intensive care unit (ICU), the criteria upon which such predisposition is based, and whether these decisions are related to structural factors of the surveyed hospitals. DESIGN: A descriptive multicenter study was made in 2010, involving the conduction of a survey in 90 hospitals, with a view to documenting the usual practice referred to LSTL upon admission in these centers. SETTING: Spanish ICUs. INTERVENTION: Opinion survey. MAIN VARIABLES OF INTEREST: Type of hospital, number of hospital beds, ICU and semicritical patient beds, usual bed availability in the ICU, use of restrictive admission criteria, use of LSTL criteria upon admission, and type of criterion used to decide LSTL. RESULTS: A total of 43 (48%) hospitals participated in the study, with LSTL being a common practice in these centers (93%). LSTL was fundamentally decided on the basis of the presence of prior severe chronic disease (95%), observation of previously declared patient will (95%), prior functional limitation (85%), and qualitative futility of care (82%). Frequent ICU bed availability (77% of the hospitals) and the use of restrictive criteria (79% of the hospitals) were also associated to patient admission with LSTL. CONCLUSIONS: Admission to ICU with LSTL is a generalized practice in Spanish Hospitals. LSTL is decided based on physiological futility from an objective medical point of view, but also in observance of ethical and moral implications based on the qualitative futility of medical care.