Plant-derived nootropics and human cognition: A systematic review.

Substances with modulatory capabilities on certain aspects of human cognition have been revered as nootropics from the dawn of time. The plant kingdom provides most of the currently available nootropics of natural origin. Here, in this systematic review, we aim to provide state-of-the-art information regarding proven and unproven effects of plant-derived nootropics (PDNs) on human cognition in conditions of health and disease. Six independent searches, one for each neurocognitive domain (NCD), were performed in parallel using three independent scientific library databases: PubMed, Cochrane and Scopus. Only scientific studies and systematic reviews with humans published between January 2000 and November 2021 were reviewed, and 256 papers were included. Ginkgo biloba was the most relevant nootropic regarding perceptual and motor functions. Bacopa monnieri improves language, learning and memory. Withania somnifera (Ashwagandha) modulates anxiety and social-related cognitions. Caffeine enhances attention and executive functions. Together, the results from the compiled studies highlight the nootropic effects and the inconsistencies regarding PDNs that require further research.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2021137.

Physicochemical Properties of Lipoproteins Assessed by Nuclear Magnetic Resonance as a Predictor of Premature Cardiovascular Disease. PRESARV-SEA Study.

Some lipoprotein disorders related to the residual risk of premature cardiovascular disease (PCVD) are not detected by the conventional lipid profile. In this case-control study, the predictive power of PCVD of serum sdLDL-C, measured using a lipoprotein precipitation method, and of the physicochemical properties of serum lipoproteins, analyzed by nuclear magnetic resonance (NMR) techniques, were evaluated. We studied a group of patients with a first PCVD event (n = 125) and a group of control subjects (n = 190). Conventional lipid profile, the size and number of Very Low Density Lipoproteins (VLDL), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL) particles, and the number of particles of their subclasses (large, medium, and small) were measured. Compared to controls, PCVD patients had lower concentrations of all LDL particles, and smaller and larger diameter of LDL and HDL particles, respectively. PCVD patients also showed higher concentrations of small dense LDL-cholesterol (sdLDL), and triglycerides (Tg) in LDL and HDL particles (HDL-Tg), and higher concentrations of large VLDL particles. Multivariate logistic regression showed that sdLDL-C, HDL-Tg, and large concentrations of LDL particles were the most powerful predictors of PCVD. A strong relationship was observed between increased HDL-Tg concentrations and PCVD. This study demonstrates that beyond the conventional lipid profile, PCVD patients have other atherogenic lipoprotein alterations that are detected by magnetic resonance imaging (MRI) analysis.

Cuidados del paciente con ileostomía complicada por una hernia paraestomal / No disponible

Se presenta un caso de un paciente diagnosticado de neoplasia en el recto al que se le practica una ileostomía temporal que se complica por una hernia paraestomal. Como consecuencia, presenta mucho dolor y, debido a las particularidades de la ostomía, su calidad de vida se encuentra comprometida. Se realiza un plan de cuidados ofreciendo, además, dispositivos y recursos adecuados para el manejo de su ileostomía. Con el propósito de minimizar complicaciones y favorecer la resolución de los problemas presentes, se presta información sobre el autocuidado, haciendo hincapié en el control estricto de la evolución del estoma y de la piel periestomal

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Síndrome de burnout en médicos residentes de los hospitales del área sureste de la Comunidad de Madrid / Burnout syndrome in internal medical residents in the southeast area's hospitals of Madrid

El Síndrome de Burnout se reconoce como un problema global importante entre los trabajadores de atención médica, produciendo agotamiento, despersonalización y baja realización personal en los trabajadores. Objetivo: determinar la prevalencia del síndrome de Burnout entre los médicos residentes de diversas especialidades y evaluar los factores asociados. Material y Métodos: estudio observacional transversal. Se utilizaron el cuestionario del Inventario de Burnout de Maslach y un cuestionario sociodemográfico para evaluar los factores asociados en médicos internos residentes de hospitales del área sureste de Madrid. Participaron 119 residentes en el estudio. Resultados: encontramos una prevalencia de Burnout en los residentes encuestados de 29,4%. El único factor que se ha visto asociado a una mayor prevalencia de Burnout fue ser mujer. No se encontraron factores asociados a las dimensiones cansancio emocional ni realización personal, sin embargo sí se encontraron factores asociados a la dimensión despersonalización, así se vio que tener personas a cargo es un riesgo y estar en los últimos años de residencia es un factor de protección para desarrollar mayor grado de despersonalización. Conclusión: la prevalencia de agotamiento en los médicos residentes está de acuerdo con estudios anteriores. La identificación temprana de los factores de riesgo es fundamental para desarrollar soluciones e intervenciones que podrían mejorar la condición laboral de los médicos residentes

Burnout Syndrome is recognized as an important global problem among health care workers, producing exhaustion as a result of emotional demands, depersonalization as a cynical, negative response to patient care and reduced achievement refers to the belief that you can no longer work effectively. All this leads to a major concern among doctors due to their high level of stress at work. Objective: determine the prevalence of Burnout Syndrome among internal medical residents of various specialties and evaluate the associated factors. Methods: cross-sectional observational study. The Maslach Burnout Inventory questionnaire and a sociodemographic questionnaire were used to evaluate the factors associated with the syndrome in internal medical residents the southeast area of Madrid. Burnout was defined as the association of high emotional exhaustion, depersonalization and low professional performance. From all 569 internal medical residents just 119 participated in the study. Results: the prevalence of Burnout in the internal medical residents surveyed was 29.4%. The only factor that showed association with a higher prevalence of Burnout was being a woman. No factors showed association with the dimensions emotional fatigue or personal fulfillment. However, having people in charge seems to be a risk factor and being in the last years of medical residence seems to be a risk protective factor for developing a higher degree of depersonalization. Conclusion: the prevalence of exhaustion in internal medical residents is in agreement with previous studies. The early identification of risk factors is essential to develop solutions and interventions that could improve the working condition of internal medical residents as preventive measures against Burnout Syndrome

Gestación tras cirugía de Fontan-Kreutzer / Pregnancy after Fontan-Kreutzer surgery

No disponible

Comparison of two competitive enzyme immunoassay kits for quantification of plasma Urotensin-II in rats.

Changes in Urotensin-II (U-II) concentration, a potent vasoconstrictor peptide, have been detected in various pathologies, but it has been impossible to define a normality range. We aimed to analyze the concordance and interchangeability between two enzyme immunoassay methods developed by Phoenix Pharmaceuticals, Inc. to measure U-II plasma concentration in rats: ELISA and fluorescent EIA. Assays resulted positively correlated (r = 0.850; p < 0.01). There was a significant difference between assays values (p < 0.001). The analysis of agreement (Bland and Altman plot) stated that the mean of the differences was 2.055 (SD ± 0.588). Hence, we concluded that the two U-II assays were correlated but not interchangeable.

First-trimester screening biochemical markers (free beta-subunit human chorionic gonadotropin, pregnancy-associated plasma protein-A) and risk of early fetal loss.

AIM: The aim of this work was to assess the risk of early fetal loss (first trimester of pregnancy, 8-13 weeks of gestation) using the results of first-trimester screening (FTS) biochemical markers independently and combined. METHODS: FTS results of 152 women who suffered early fetal loss were compared to a control group of 150 women with normal pregnancy outcomes. FTS biochemical markers were measured with a Delfia Xpress 6000 analyzer and biochemical risks for Down's and Edward's syndromes were calculated using Prenatal-Lifecycle version 3.0 software. Marker levels were standardized by calculating the gestational-specific multiple of the medians (MoM), further adjusted by maternal age, maternal weight, cigarette consumption and pre-existing type 1 diabetes mellitus. Receiver-operator curves were built to evaluate each marker and its combination. RESULTS: Our results show that values of biochemical risk of t21 of more than 1 in 310 have a poor sensitivity to predict early fetal loss (31.4%) with a positive predictive value (PPV) for fetal loss of 67.7%. Values of pregnancy-associated plasma protein A (PAPP-A) MoM of less than 0.48 show a sensitivity of 62.1% and a PPV of 84.5% for early fetal loss; whereas for free ß-human chorionic gonadotropin, values of MoM of less than 0.44 have a sensitivity of 66.4% with a PPV of 85.3%. A novel algorithm, consisting in the multiplication of both markers, shows for values of less than 0.48 a sensitivity of 83.1%, a specificity of 78.7% and a PPV of 77.1%. CONCLUSION: Combined analysis of PAPP-A and free ß-hCG appears to be a potential candidate to predict early fetal loss.

Psychoeducative groups help control type 2 diabetes in a primary care setting.

INTRODUCTION: The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c), the body mass index (BMI) and cardiovascular risk factors (CVRF) compared with conventional educational measures provided individually. METHODS: A quasi-experimental study (pre/post-intervention) with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m2).The beneficial effect of psychoeducational group therapy in the study group (PGT) was compared with conventional diabetes education in the control group (CG). RESULTS: The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003), met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005) and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002) than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05). CONCLUSIONS: PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care.

Introducción: Los cambios en el estilo de vida mejoran el control de los diabéticos tipo 2, pero no sabemos cuales son las estrategias más eficientes para conseguir estos cambios. Hemos medido el impacto de una intervención psicoeducativa grupal en diabetes mediante hemoglobina glicosilada (HbA1c), índice de masa corporal (IMC) y factores de riesgo cardiovascular (FRCV). Métodos: Se trata de un ensayo clínico controlado, randomizado y multicéntrico, de 72 pacientes diabéticos tipo 2, edad media 63,08 AÑOs, 50% mujeres, HbA1c media 6.98% e IMC medio 30,48 kg/m2. Se comparó el efecto terapéutico de una intervención psicoeducativa grupal(GSE) con una educación diabetológica convencional (GC). Resultados: El GSE presentó una mayor reducción media de HbA1c, -0,51 ± 1,07 vs -0,06 ± 0,53% (p 0,003), un mayor grado de cumplimiento de los objetivos de control óptimo de HbA1c, 80% vs 48% (p 0,005) y una mayor reducción media de peso, -1,93 ± 3,57 vs 0,52 ± 1,73 kg (p 0,002), que el GC. También se objetivó una mejoría significativa de colesterol total, colesterol LDL, triglicéridos, tensión arterial sistólica y diastólica en GSE (todas las p < 0,05). Conclusiones: Los GSE de diabéticos tipo 2 consiguieron una mejoría significativa de HbA1c, IMC y FRCV, y superaron a la educación diabetológica convencional en el grado de cumplimiento de los objetivos de control óptimo de la diabetes. Debemos plantearnos cambios estructurales en nuestros programas asistenciales para introducir estos avances más eficientes en educación terapeútica de diabetes en atención primaria.

Psychoeducative groups help control type 2 diabetes in a primary care setting / La terapia psicoeducativa grupal en atención primaria ayuda en el control de la diabetes tipo 2

Introduction: The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c), the body mass index (BMI) and cardiovascular risk factors (CVRF) compared with conventional educational measures provided individually. Methods: A quasi-experimental study (pre/post-intervention) with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m2). The beneficial effect of psychoeducational group therapy in the study group (PGT) was compared with conventional diabetes education in the control group (CG). Results: The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003), met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005) and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002) than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05). Conclusions: PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care (AU)

Introducción: Los cambios en el estilo de vida mejoran el control de los diabéticos tipo 2, pero no sabemos cuales son las estrategias más eficientes para conseguir estos cambios. Hemos medido el impacto de una intervención psicoeducativa grupal en diabetes mediante hemoglobina glicosilada (HbA1c), índice de masa corporal (IMC) y factores de riesgo cardiovascular (FRCV). Métodos: Se trata de un ensayo clínico controlado, randomizado y multicéntrico, de 72 pacientes diabéticos tipo 2, edad media 63,08 años, 50% mujeres, HbA1c media 6.98% e IMC medio 30,48 kg/m2. Se comparó el efecto terapéutico de una intervención psicoeducativa grupal (GSE) con una educación diabetológica convencional (GC).Resultados: El GSE presentó una mayor reducción media de HbA1c, -0,51 ± 1,07 vs -0,06 ± 0,53% (p 0,003), un mayor grado de cumplimiento de los objetivos de control óptimo de HbA1c, 80% vs 48% (p 0,005) y una mayor reducción media de peso, -1,93 ± 3,57 vs 0,52 ± 1,73 kg (p 0,002), que el GC. También se objetivó una mejoría significativa de colesterol total, colesterol LDL, triglicéridos, tensión arterial sistólica y diastólica en GSE (todas las p < 0,05). Conclusiones: Los GSE de diabéticos tipo 2 consiguieron una mejoría significativa de HbA1c, IMC y FRCV, y superaron a la educación diabetológica convencional en el grado de cumplimiento de los objetivos de control óptimo de la diabetes. Debemos plantearnos cambios estructurales en nuestros programas asistenciales para introducir estos avances más eficientes en educación terapeútica de diabetes en atención primaria (AU)

Trombolisis intraarterial e intravenosa en el ictus isquémico agudo. Tiempo es cerebro / Intraarterial and intravenous thrombolysis in acute ischemic stroke. Time is brain

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Prevenir complicaciones circulatorias. Plan de cuidados estandarizados / Standardized treatment plan to prevent. Circulatory complications

Se plantea la necesidad de estandarizar los cuidados básicos a los pacientes encamados para evitar las complicaciones circulatorias. Si protocolizamos las intervenciones enfermeras en el manejo de este tipo de pacientes y las actividades derivadas de las mismas, podremos actuar precozmente para conseguir nuestro objetivo. Proponemos el siguiente Plan de Cuidados Estandarizado siempre teniendo en cuenta que se trata de un protocolo específico de cuidados, apropiado para pacientes encamados con riesgo de padecer complicaciones circulatorias. No hay que olvidar que los planes de cuidados estandarizados nos servirán como modelo, pero que necesariamente tendremos que personalizarlos con cada paciente(AU)

The authors present the necessity to standardize basic treatment protocols for bedridden patients in order to avoid circulatory complications. If we set up protocols for nursing treatment when dealing with this type of patients and the activities derived from this care, we can act precociously to achieve our objective. The authors propose the following Standardized Treatment Plan bearing in mind that this is a protocol for a specific situation, appropriate for bedridden patients who suffer the risk of circulatory complications. One should not forget that standardized treatment plans serve as a model, but it is necessary for nurses to personalize each plan for each patient(AU)

Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study.

INTRODUCTION: Higher and lower cerebral perfusion pressure (CPP) thresholds have been proposed to improve brain tissue oxygen pressure (PtiO2) and outcome. We study the distribution of hypoxic PtiO2 samples at different CPP thresholds, using prospective multimodality monitoring in patients with severe traumatic brain injury. METHODS: This is a prospective observational study of 22 severely head injured patients admitted to a neurosurgical critical care unit from whom multimodality data was collected during standard management directed at improving intracranial pressure, CPP and PtiO2. Local PtiO2 was continuously measured in uninjured areas and snapshot samples were collected hourly and analyzed in relation to simultaneous CPP. Other variables that influence tissue oxygen availability, mainly arterial oxygen saturation, end tidal carbon dioxide, body temperature and effective hemoglobin, were also monitored to keep them stable in order to avoid non-ischemic hypoxia. RESULTS: Our main results indicate that half of PtiO2 samples were at risk of hypoxia (defined by a PtiO2 equal to or less than 15 mmHg) when CPP was below 60 mmHg, and that this percentage decreased to 25% and 10% when CPP was between 60 and 70 mmHg and above 70 mmHg, respectively (p < 0.01). CONCLUSION: Our study indicates that the risk of brain tissue hypoxia in severely head injured patients could be really high when CPP is below the normally recommended threshold of 60 mmHg, is still elevated when CPP is slightly over it, but decreases at CPP values above it.

Impact of ventilator-associated pneumonia in patients with severe head injury.

BACKGROUND: The impact of ventilator-associated pneumonia (VAP) on outcome seems to vary depending on the critically ill patients we analyze. Our objective, therefore, has been to evaluate the influence of VAP on the mortality and morbidity in patients with severe head injury (Glasgow Coma Scale score