Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation.

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

Impacto de la movilización en pacientes portadores de soporte circulatorio mecánico de corta duración tipo Levitronix® CentriMag como puente a trasplante cardíaco / Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation

Introducción: Pese a los beneficios de la movilización en el paciente crítico, la evidencia de su aplicación en pacientes portadores de Levitronix® CentriMag como puente a trasplante cardíaco (TC) es prácticamente nula. El objetivo del estudio fue analizar el impacto de la movilidad en estos pacientes. Métodos: Estudio observacional retrospectivo. Se incluyeron los pacientes sometidos a un TC previamente portadores de Levitronix® CentriMag ingresados entre el 2010 y el 2019 en el Hospital Universitario de Bellvitge. Se relacionaron las variables grado de movilidad y estado nutricional con la evolución clínica posterior al TC (infecciones, tiempo de estancia en UCI y mortalidad). Resultados: Los 27 pacientes seleccionados se dividieron en dos grupos según el grado de movilidad (22 baja y 5 alta). Se observó una supervivencia a 90 días post-TC del 63,6% en el grupo de pacientes con movilidad baja, mientras que en el grupo con movilidad alta fue del 80%; no se observaron diferencias estadísticamente significativas. Tampoco las hubo en la distribución de las altas de UCI desde el TC a 30 días. Por otro lado, se observaron unos menores niveles de albúmina en el grupo de movilidad baja, con una diferencia estadísticamente significativa (24,5 g/L [RIC: 23-30] vs. 33 g/L [RIC: 26-36]; p = 0,029). También se observaron diferencias en la mediana de días de ventilación mecánica invasiva (VMI) post-TC (p = 0,014), siendo mayor en el grupo de movilidad baja. No se observaron diferencias en la aparición de infecciones ni UPP. Conclusiones: Los pacientes con un grado de movilidad alto presentaron un menor tiempo de VMI y un mejor estado nutricional. No se observaron complicaciones asociadas a la movilidad. No se encontraron diferencias significativas entre el grado de movilidad y la mortalidad a 90 días, el tiempo de ingreso en UCI, la aparición de infecciones o UPP post-TC.(AU)

Introduction: Despite the benefits of mobilization in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is almost absent. The objective of this study is to analyze the impact of mobility on these patients. Methods: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to “Hospital Universitario de Bellvitge” (Barcelona). Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. Results: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24.5 g/L (IQR: 23-30) vs. 33 g/L (IQR: 26-36); p = 0.029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = 0.014). There were no significant differences in appearance of pressure ulcers, or post-HT infections among mobility groups. Conclusions: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post-HT adverse events.(AU)

Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital.

GOAL: The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD: This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (CPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS: 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was CPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS: The use of CPR in well-selected patients can improve their survival.

Supervivencia al alta hospitalaria de los pacientes sometidos a terapia ECMO tras PCR en un hospital de tercer nivel / Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital

Objetivo El objetivo del estudio fue analizar la supervivencia al alta hospitalaria de los pacientes tras la instauración de una membrana de oxigenación extracorpórea veno-arterial (ECMO-VA) durante paro cardiorrespiratorio (simultáneamente o durante las 6 horas posteriores a este) en un hospital de tercer nivel español. Metodología Estudio descriptivo y retrospectivo de los pacientes sometidos a una terapia ECMO-VA durante o tras maniobras de reanimación cardiopulmonar (ERCP) en los últimos 10 años. Las variables fueron extraídas de la historia clínica electrónica de cada paciente. Resultados Se implantaron 175 ECMO, el 84% (147) fueron ECMO-VA y el 17% (25) su indicación fue de ECPR. El 40% (10) la terapia ECMO se inició simultáneamente durante las maniobras de RCP y el resto (15) en las 6 horas posteriores. Se obtuvieron tasas de supervivencia del 44%. Conclusiones El uso de la ERCP a pacientes bien seleccionados puede mejorar su supervivencia. (AU)

Goal The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. Method This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. Results 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. Conclusions The use of CPR in well-selected patients can improve their survival. (AU)

Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos / Management of temperature control in post-cardiac arrest care: an expert report

Actualmente, el control estricto de temperatura mediante hipotermia inducida (entre 32 y 36 oC) se considera un tratamiento de primera línea en el manejo de pacientes con parada cardiaca recuperada que ingresan en Unidades de Cuidados Intensivos. Su objetivo es disminuir el daño neurológico secundario a anoxia cerebral. Aunque existen múltiples evidencias sobre sus beneficios, el empleo de esta técnica en nuestro país es pobre y todavía existen temas controvertidos como temperatura óptima, velocidad de instauración, duración y proceso de calentamiento. El objetivo de este trabajo es desarrollar la evidencia científica actual y las recomendaciones de las principales guías internacionales. El enfoque de este documento se centra también en aplicación práctica del control estricto de la temperatura en la parada cardiaca recuperada en nuestras Unidades de Cuidados Intensivos Generales o Cardiológicas, principalmente en los métodos de aplicación, protocolos, manejo de las complicaciones y elaboración del pronóstico neurológico. (AU)

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis. (AU)

Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. / Supervivencia al alta hospitalaria de los pacientes sometidos a terapia ECMO tras PCR en un hospital de tercer nivel.

GOAL: The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD: This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS: 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS: The use of CPR in well-selected patients can improve their survival.

Management of temperature control in post-cardiac arrest care: an expert report. / Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos.

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis.

Donor-transmitted malaria after heart transplant managed successfully with artesunate.

Donor-transmitted malaria is a rare complication in solid organ transplantation, which causes high mortality. Data concerning the use of artesunate in solid organ transplant recipients are lacking. We report a heart transplant patient who developed donor-derived severe Plasmodium falciparum malaria, successfully treated with artesunate. Transmission of malaria to 2 of the other transplant recipients from the same donor was also documented.

Síndrome de Tako-Tsubo. Discinesia transitoria del ventrículo izquierdo / Takotsubo syndrome. Transient left ventricular dyskinesia

El síndrome de Tako-Tsubo, llamado también síndrome de discinesia apical transitoria, fue descrito por primera vez en Japón en los años noventa. Es una entidad poco frecuente cercana al 1% de todos los pacientes con sospecha de síndrome coronario agudo. Generalmente afecta a mujeres posmenopáusicas con pocos factores de riesgo cardiovascular. Se caracteriza por dolor precordial anginoso, cambios electrocardiográficos, elevación de enzimas de daño miocárdico, ausencia de obstrucción coronaria en la angiografía y una característica discinesia anteroapical del ventrículo izquierdo que se normaliza en unos pocos días. El estrés emocional severo es el desencadenante más común. La etiopatogenia de este síndrome está aún por definir. Este síndrome se considera entidad clínica desde el año 2001, cuando se publicó una serie de 88 casos. Tiene un mecanismo parcialmente conocido, caracterizado por la morfología que adopta el ventrículo izquierdo secundaria a hipocinesia o discinesia de los segmentos apicales e hipercontractilidad de los basales. A diferencia del síndrome coronario agudo, los pacientes con disfunción del ventrículo izquierdo no presentan enfermedad aterotrombótica en las arterias coronarias; además, las alteraciones descritas poseen un carácter reversible. Se han propuesto unos criterios clínicos diagnósticos, existiendo en la actualidad cierta controversia en los mismos, así como en las exploraciones complementarias necesarias para su diagnóstico (AU)

The Takotsubo syndrome, also called transient apical dyskinesia syndrome, was first described in Japan in the 1990s. It is a rare entity found in almost 1% of all patients with suspicion of acute coronary syndrome. It usually affects postmenopausal women with a few cardiovascular risk factors. It is characterized by angina-type chest pain, electrocardiographic changes, elevation of the enzymes of myocardial injury, absence of coronary obstruction on angiography, and a characteristic left ventricular anteroapical dyskinesia, which returns to normal within a few days. Severe emotional stress is the most common trigger for this syndrome. The aetiopathogenesis of this syndrome remains to be defined. This syndrome has been considered a clinical condition since 2001, when a series of 88 cases was published. It is a disease with a partially known mechanism, characterised by the morphology adopted by the left ventricle secondary to hypokinesis or dyskinesia of the apical segments, and hypercontractility of basal segments. Unlike acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. In addition, the alterations described are reversible. Some clinical diagnostic criteria have been proposed, although they are still controversial, as well as in the complementary examinations required for diagnosis (AU)

[Takotsubo syndrome. Transient left ventricular dyskinesia]. / Síndrome de Tako-Tsubo. Discinesia transitoria del ventrículo izquierdo.

The Takotsubo syndrome, also called transient apical dyskinesia syndrome, was first described in Japan in the 1990s. It is a rare entity found in almost 1% of all patients with suspicion of acute coronary syndrome. It usually affects postmenopausal women with a few cardiovascular risk factors. It is characterized by angina-type chest pain, electrocardiographic changes, elevation of the enzymes of myocardial injury, absence of coronary obstruction on angiography, and a characteristic left ventricular anteroapical dyskinesia, which returns to normal within a few days. Severe emotional stress is the most common trigger for this syndrome. The aetiopathogenesis of this syndrome remains to be defined. This syndrome has been considered a clinical condition since 2001, when a series of 88 cases was published. It is a disease with a partially known mechanism, characterised by the morphology adopted by the left ventricle secondary to hypokinesis or dyskinesia of the apical segments, and hypercontractility of basal segments. Unlike acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. In addition, the alterations described are reversible. Some clinical diagnostic criteria have been proposed, although they are still controversial, as well as in the complementary examinations required for diagnosis.

La seguridad en los cuidados de los pacientes en las emergencias extrahospitalarias / Patient safety in extra-hospital emergencies

Uno de los grandes retos de la sanidad mundial es la seguridad clínica del paciente. En la asistencia prehospitalaria urgente y emergente se producen errores que afectan a la seguridad. Se fomenta la cultura de seguridad y se ponen herramientas a disposición del profesional. Objetivo. Planteamos como hipótesis que el cumplimiento de estándares de seguridad en la atención a los pacientes que utilizan los sistemas de emergencia extrahospitalaria mejora la atención y minimiza sus riesgos. Nos trazamos como objetivo confeccionar un instrumento que permitiese evaluar la calidad de la seguridad del paciente que requiere de los servicios de emergencias extrahospitalarias. Método. Para la creación de esta herramienta nos hemos basado en el estudio SÉNECA, utilizando como base el Modelo Europeo de Calidad de la European Foundation of Quality Management (EFQM). La creación de los indicadores se realizó mediante metodología Delphi. Resultados. Se propusieron 74 indicadores, de los cuales 9 fueron propuestos por los panelistas, aceptandose el 44%. Creándose una herramienta definitiva de 41 indicadores. Los indicadores más destacados fueron; «Se controlan las caducidades del material fungible y fármacos que se almacenan en las unidades» agrupado en «alianzas y recursos» y «pacientes que no cumplen el régimen terapéutico por dudas no resueltas» agrupado en «resultados claves». Conclusiones. La utilización del modelo EFQM para construir la herramienta de evaluación permite estructurar de manera adecuada la información y organiza los estándares e indicadores de seguridad de una manera coherente. La metodología utilizada permite proponer una herramienta adaptada para medir la seguridad del paciente extrahospitalario. La aplicación de esta herramienta permitirá identificar áreas de mejora relacionadas con la seguridad del paciente(AU)

One of the biggest challenges for the public health sector is to ensure the clinical safety of the patient, which is affected by mistakes made in pre-hospital emergency care. A culture of safety is encouraged and health professionals have tools at their disposal to help them maintain that safety. Objetive. We propose as a hypothesis that compliance with safety standards in for the care of patients using extra-hospital emergency systems improves care and minimize risks. Our goal is to build a tool that enables us to measure the safety quality for patients in need of non-hospital emergency services. Method. To create this tool we have taken the SENECA study as a basis, and using the European Quality Model of the European Foundation of Quality Management (EFQM). The indicators were created using the Delphi Method. Results. A total of 74 indicators were proposed, 9 of which were proposed by the panelists, and 44% being accepted. A definitive tool of 41 indicators was created. The most notable indicators were; “The expiry dates of consumable material and drugs that are stored in the units are controlled” grouped in “Alliances and resources”, and “Patients who do not adhere to treatment due to unresolved doubts” grouped in “Key results”. Conclusions. The use of the EFQM model to build the assessment tool allows information to be appropriately structured and to organize safety standards and indicators of security in a consistent manner. This methodology helped to propose a suitable tool for measuring patient safety in an extra-hospital situation. The application of this tool will identify areas for improvement related to the patient safety(AU)

[Patient safety in extra-hospital emergencies]. / La seguridad en los cuidados de los pacientes en las emergencias extrahospitalarias.

UNLABELLED: One of the biggest challenges for the public health sector is to ensure the clinical safety of the patient, which is affected by mistakes made in pre-hospital emergency care. A culture of safety is encouraged and health professionals have tools at their disposal to help them maintain that safety. OBJECTIVE: [corrected] We propose as a hypothesis that compliance with safety standards in for the care of patients using extra-hospital emergency systems improves care and minimize risks. Our goal is to build a tool that enables us to measure the safety quality for patients in need of non-hospital emergency services. METHOD: To create this tool we have taken the SENECA study as a basis, and using the European Quality Model of the European Foundation of Quality Management (EFQM). The indicators were created using the Delphi Method. RESULTS: A total of 74 indicators were proposed, 9 of which were proposed by the panelists, and 44% being accepted. A definitive tool of 41 indicators was created. The most notable indicators were; "The expiry dates of consumable material and drugs that are stored in the units are controlled" grouped in "Alliances and resources", and "Patients who do not adhere to treatment due to unresolved doubts" grouped in "Key results". CONCLUSIONS: The use of the EFQM model to build the assessment tool allows information to be appropriately structured and to organize safety standards and indicators of security in a consistent manner. This methodology helped to propose a suitable tool for measuring patient safety in an extra-hospital situation. The application of this tool will identify areas for improvement related to the patient safety.

Functionalized Fe3O4@Au superparamagnetic nanoparticles: in vitro bioactivity.

The interaction of nanoparticles with cells has been a focus of interest during the past decade. We report the fabrication and characterization of hydrosoluble Fe3O4@Au nanoparticles functionalized with biocompatible and fluorescent molecules and their interaction with cell cultures by visualizing them with confocal microscopy. Gold covered iron oxide nanoparticles were synthesized by reducing metal salts in the presence of oleylamine and oleic acid. The functionalization of these particles with an amphiphilic polymer provides a water soluble corona as well as the possibility to incorporate different molecules relevant for bio-applications such as poly(ethylene glycol), glucose or a cadaverine derived dye. The particle size, and the presence of polymer layers and conjugated molecules were characterized and confirmed by transmission electron microscopy, thermogravimetric measurements and infrared spectroscopy. A complete magnetic study was performed, showing that gold provides an optimum coating, which enhances the superparamagnetic behaviour observed above 10-15 K in this kind of nanoparticle. The interaction with cells and the cytotoxicity of the Fe3O4@Au preparations were determined upon incubation with the HeLa cell line. These nanoparticles showed no cytotoxicity when evaluated by the MTT assay and it was demonstrated that nanoparticles clearly interacted with the cells, showing a higher level of accumulation in the cells for glucose conjugated nanoparticles.

Estudio de los indicadores de rendimiento defensivos en baloncesto de alto rendimiento / No disponible

Dentro del estudio de los indicadores de rendimiento en baloncesto, la gran mayoría de trabajos analizan aspectos relacionados con la fase de ataque, apreciándose escasos trabajo de investigación en los que se analiza la defensa. Entre los estudios de acciones defensivas el aspecto más estudiado ha sido la influencia de los rebotes defensivos en el resultado final del juego, apreciándose diferencias significativas, a favor de los equipos ganadores, en cuanto a la cantidad total de rebotes defensivos capturados (García et al., 2007). En menor medida se aprecian estudios que analizan los diferentes tipos de sistemas defensivos, coincidiendo en la mayoría de los casos que la defensa de tipo individual es la más utilizada (Farinha y Tavares, 2007). En cuanto a los pases interiores, Cárdenas et al., (1999) observó que no se encontraron diferencias entre ganadores y perdedores. El objetivo de esta investigación fue analizar diferentes indicadores de rendimiento defensivos en baloncesto, estudiando las diferencias entre equipos ganadores y perdedores, así como entre defensa eficaces y no eficaces (AU)

Distrofia facioescapulohumeral de presentación temprana en dos hermanas / Early onset facioscapulohumeral dystrophy in two sisters

No disponible

No disponible