La anestesia subaracnoidea no produce disfunción ventricular izquierda transitoria en pacientes mayores de 60 años sin enfermedad cardiovascular / Spinal anesthesia does not cause left ventricular dysfunction in patients older than 60 years without cardiovascular disease

Objetivos: Evaluar la función sistólica ventricular izquierda por ecocardiograma transtorácico en pacientes mayores de 60 años, sin enfermedad cardiovascular, bajo anestesia subaracnoidea instaurada. Pacientes y métodos: Estudio observacional prospectivo con un total de 54 pacientes mayores de 60 años sin enfermedad cardiovascular, a quienes, tras la instauración de una anestesia subaracnoidea con bupivacaína hiperbárica al 0,5% con bloqueo sensitivoT10 o mayor, se les midió la función sistólica ventricular izquierda a partir del movimiento sistólico del anillo mitral (mitral anular plane systolic excursion [MAPSE].) Además, se midió el índice de colapsabilidad de vena cava inferior (ICVCI), la integral velocidad tiempo del tracto de salida del ventrículo izquierdo (ITTSVI) y del gasto cardiaco (GC). Los valores a los 5min del bloqueo se compararon con los obtenidos previamente al mismo. Resultados: Se evidenció una disminución del 3,3% del MAPSE y una ligera disminución del IVTTSVI y GC, en ningún caso con significación estadística ni clínica. El 14,8% de los pacientes presentó presión arterial media (PAM) igual o inferior a 60mmHg. La comparación de los cambios ecocardiográficos entre estos pacientes y los que no presentaron hipotensión no fueron estadísticamente significativos ni clínicamente relevantes. Discusión: Se demuestra que la anestesia subaracnoidea con nivel anestésico T10 o superior en pacientes mayores de 60 años sin enfermedad cardiovascular, es una técnica segura ya que no altera de forma significativa parámetros ecocardiográficos de medición de la función sistólica ventricular izquierda.(AU)

Background: Elderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. Objectives: To evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. Patients and methods: Prospective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 minutes after the blockade were compared with those obtained previously. Results: A 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. The 14.8% of the patients presented MAP equal to or less than 60mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. Discussion: Our study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.(AU)

Spinal anesthesia does not cause left ventricular dysfunction in patients older than 60 years without cardiovascular disease.

BACKGROUND: Elderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. OBJECTIVES: To evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. PATIENTS AND METHODS: Prospective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 min after the blockade were compared with those obtained previously. RESULTS: A 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. 14.8% of the patients presented MAP equal to or less than 60 mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. DISCUSSION: Our study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.

High ultrasensitive serum C-reactive protein may be related to freezing of gait in Parkinson's disease patients.

C-reactive protein (CRP) is a biomarker of systemic inflammation that has been linked to accelerated decline in walking speed in older adults. The aim of the present study was to compare the CRP levels of PD patients with vs patients without freezing of gait (FOG). Patients and controls participating in the COPPADIS-2015 study that performed blood extraction for determining molecular serum biomarkers were included. Patients with FOG were identified as those with a score of 1 or greater on item-3 of the Freezing of Gait Questionnaire (FOG-Q). Immunoassay was used for determining ultrasensitive CRP (US-CRP) level (mg/dL). In the PD group (n = 225; 61.8 ± 9.5 years old, 61.8% males), 32% of the patients presented FOG but none in the control group (n = 65; 60.3 ± 6.1 years old, 56.9% males) (p < 0.0001). Differences in US-CRP level were significant in patients with FOG vs patients without FOG and vs controls (0.31 ± 0.52 vs 0.16 ± 0.21 vs 0.21 ± 0.22; p = 0.04). Significant differences were also observed between patients with vs without FOG (p = 0.001) but not between patients and controls (p = 0.163). US-CRP level was related to FOG (OR = 4.369; 95% CI 1.105-17.275; p = 0.036) along with H&Y (OR = 2.974; 95% CI 1.113-7.943; p = 0.030) and non-motor symptoms burden (NMSS total score; OR = 1.017; 95% CI 1.005-1.029; p = 0.006) after adjusting for age, gender, disease duration, equivalent daily levodopa dose, number of non-antiparkinsonian drugs per day, motor fluctuations, cognition, motor phenotype, and chronic use of anti-inflammatory drugs. The present study suggests that serum US-CRP level is related to FOG in PD patients. Inflammation could be linked to FOG development.

Radiological evaluation of the transuranic remaining contamination in Palomares (Spain): A historical review.

This paper shows the studies carried out in Palomares (Almería, Spain) following the ground dispersion of nuclear material as a result of the air crash accident that took place in 1966, in which four nuclear bombs were involved. As a consequence of the Palomares accident, plutonium (Pu) and uranium (U) were dispersed over an area of approximately 2.3 km2 due to the chemical explosion of two of them. The most relevant activities carried out by CIEMAT, along with other national and international institutions in the Palomares scenario are detailed. These activities, performed for over 50 years, focus mainly in the characterization of the contamination source, in the continuous environmental and personal radiological monitoring programs, in the construction of a detailed superficial and 3-D mapping distribution of the remaining contamination and in the evaluation of the bioavailability of the transuranics still remaining in the area.

Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer.

BACKGROUND: Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in non-small cell lung cancer (NSCLC) patients. METHODS: A prospective multi-institutional study was conducted with locally advanced and oligometastatic NSCLC patients. All participants were evaluated at baseline, end of CCRT, week 6, 12, 24, and 48 post-CCRT. They completed forced spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity (DLCO), molar mass of CO2, six-minute walk test and exhaled fraction of nitric oxide (FeNO). Radiation pneumonitis was assessed with RTOG and CTCAE. The protocol was registered in www.clinicaltrials.gov (NCT01580579), registered April 19, 2012. RESULTS: Fifty-two patients were enrolled; 37 completed one-year follow-up. RP ≥ Grade 2 was present in 11/37 (29%) for RTOG and 15/37 (40%) for CTCAE. Factors associated with RP were age over 60 years and hypofractionated dose. PFT abnormalities at baseline that correlated with the development of RP included lower forced expiratory volume in one second after bronchodilator (p = 0.02), DLCO (p = 0.02) and FeNO (p = 0.04). All PFT results decreased after CCRT and did not return to basal values at follow-up. CONCLUSIONS: FEV1, DLCO and FeNO prior to CCRT predict the development of RP in NSCLC. This study suggests that all patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment.

Synthesis, Characterization, Uses and Applications of Porous Clays Heterostructures: A Review.

Porous clay heterostructures (PCH) are obtained by the insertion of an organic bulky cation in the interlayer spacing of a smectite, causing a swelling of the clay mineral. Right after, oxides species, mainly silicon oxide, are incorporated as pillars galleries between adjacent layers to form a porous structure after the removal of the template. The ordering of the clay mineral as well the organic cation incorporated in the synthetic step favors the modulation of the textural properties of the PCH. In addition, the incorporation of heteroatoms in the pillars galleries can also modulate the acidity of the PCH. The modulation of the pore size and the acid properties provides to these materials a wide range of applications in the fields of adsorption and catalysis. This paper carries out a detailed review of the synthesis of PCH, characterization as well as uses and application reported in the literature.

Comparison of bacteriological conversion and treatment outcomes among MDR-TB patients with and without diabetes in Mexico: Preliminary data.

Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) treated with second-line anti-TB drugs. The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion) and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City. RESULTS: Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (e.g. MDR-TB with additional resistance to one injectable drug or a fluoroquinolone, 12.2%) and 6 (6.7%) with XDR-TB. Out of these, 49 (54.4%) had DM and 42 (86%) were undergoing insulin treatment. No statistically significant differences were found in treatment outcomes comparing DM vs. non-DM MDR-TB cases: 18/32 (56.3%) of DM cases and 19/24 (79.2%) non DM patients achieved treatment success (p=0.07). The time to sputum smear and culture conversion was longer (although not statistically) in patients without DM, as follows: the mean (±SD) time to sputum smear conversion was 53.9 (±31.4) days in DM patients and 65.2 (±34.8) days in non-DM ones (p=0.15), while the time to culture conversion was 66.2 (±27.6) days for DM and 81.4 (±37.7) days for non-DM MDR-TB cases (p=0.06). CONCLUSIONS: The study results support the Mexican National TB programme to strengthen its collaboration with the DM programme, as an entry point for TB (and latent TB infection) screening and management.

Pharmacological and neuroethological study of the acute and chronic effects of lamotrigine in the genetic audiogenic seizure hamster (GASH:Sal).

The present study aimed to investigate the behavioral and anticonvulsant effects of lamotrigine (LTG) on the genetic audiogenic seizure hamster (GASH:Sal), an animal model of audiogenic seizure that is in the validation process. To evaluate the efficiency of acute and chronic treatments with LTG, GASH:Sals were treated with LTG either acutely via intraperitoneal injection (5-20mg/kg) or chronically via oral administration (20-25mg/kg/day). Their behavior was assessed via neuroethological analysis, and the anticonvulsant effect of LTG was evaluated based on the appearance and the severity of seizures. The results showed that acute administration of LTG exerts an anticonvulsant effect at the lowest dose tested (5mg/kg) and that chronic oral LTG treatment exerts an anticonvulsant effect at a dose of 20-25mg/kg/day. Furthermore, LTG treatment induced a low rate of secondary adverse effects. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".

Acquisition of Competencies by Medical Students in Neurological Emergency Simulation Environments Using High Fidelity Patient Simulators.

The training of medical students demands practice of skills in scenarios as close as possible to real ones that on one hand ensure acquisition of competencies, and on the other, avoid putting patients at risk. This study shows the practicality of using high definition mannequins (SimMan 3G) in scenarios of first attention in neurological emergencies so that medical students at the Faculty of Medicine of the University of Salamanca could acquire specific and transversal competencies. The repetition of activities in simulation environments significantly facilitates the acquisition of competencies by groups of students (p < 00.5). The greatest achievements refer to skills whereas the competencies that demand greater integration of knowledge seem to need more time or new sessions. This is what happens with the competencies related to the initial diagnosis, the requesting of tests and therapeutic approaches, which demand greater theoretical knowledge.

Percepción de las enfermeras de UCI en relación al cuidado satisfactorio: convergencias y divergencias con la percepción del paciente crítico / Perception of uci nurses in relation with satisfactory care: convergences and divergences with the perception of critical patients

Objetivo: Explorar las convergencias y divergencias entre la percepción de las enfermeras y los pacientes críticos, en relación a los cuidados satisfactorios proporcionados y recibidos. Métodos: Forma parte de un estudio cualitativo más amplio, según la Teoría Fundamentada. Realizado en 3 Unidades de Cuidados Intensivos con 34 boxes. Muestreo teórico por perfiles con n = 19 pacientes y n = 7 enfermeras tras la saturación de datos. El reclutamiento de pacientes incluidos en los perfiles de edad avanzada y larga estancia se dilató en el tiempo por la baja incidencia de estos. La recogida de datos consistió en: entrevista en profundidad a los pacientes críticos, grupo de discusión de enfermeras expertas en el cuidado al paciente crítico y diario de campo. Análisis temático de Teoría Fundamentada según Strauss y Corbin: codificación abierta, axial y selectiva. Se siguieron los criterios de rigor de Guba y Lincoln, de calidad de Calderón y los de reflexividad ética de Gastaldo y McKeever. Se obtuvo informe favorable del comité de ética del centro y consentimiento informado de los participantes. Resultados: Emergen 4 categorías coincidentes: las competencias profesionales, los cuidados humanos, técnicos y continuados. La combinación de estos elementos producen sentimientos de seguridad, tranquilidad, sentirse persona permitiendo al paciente una relación cercana y de confianza con la enfermera que realiza cuidados individualizados. No se han encontrado categorías divergentes. Conclusiones: Las percepciones de las enfermeras en relación a los cuidados coinciden con las percepciones de los pacientes críticos tanto en la definición como en las dimensiones sobre el cuidado satisfactorio

Objective: Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received. Methods: It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n = 19 patients and n = 7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants. Results: Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found. Conclusions: Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care

Enfermedades inflamatorias mediadas por inmunidad y otras comorbilidades en pacientes con psoriasis. Características basales de la cohorte de pacientes con psoriasis del estudio AQUILES / Immune-Mediated Inflammatory Diseases and Other Comorbidities in Patients With Psoriasis: Baseline Characteristics of Patients in the AQUILES Study

Introducción y objetivos: Los pacientes con psoriasis presentan con frecuencia comorbilidades, incluyendo otras enfermedades inflamatorias mediadas por inmunidad (EIMI) y factores de riesgo cardiovascular (FRCV). El objetivo de este trabajo es describir la prevalencia basal de otras EIMI y comorbilidades en una cohorte de pacientes con psoriasis. Pacientes y métodos: AQUILES es un estudio observacional prospectivo multicéntrico de 3 cohortes de pacientes (psoriasis, espondiloartritis y enfermedad inflamatoria intestinal [EII]), para evaluar la coexistencia de EIMI y otras comorbilidades. En la cohorte con psoriasis se incluyeron pacientes ≥ 18 años atendidos en consultas hospitalarias de dermatología. Se recogió información sobre datos demográficos y clínicos de acuerdo a un protocolo preespecificado. Resultados: Se incluyeron 528 pacientes con psoriasis (edad media: 46,7 años; 60,2% hombres; 39,8% mujeres; 89,8% psoriasis en placas; mediana de PASI 3,2 [1,5-7,4]). Presentaron otra EIMI 82 pacientes (15,5% [IC 95%: 12,7-18,9]). El 14,0% (IC 95%: 11,3-17,2) presentó espondiloartritis (la mayoría de estos artritis psoriásica [prevalencia 13,1%, IC 95%: 10,5-16,2), el 1,3% EII (IC 95%: 0,6-2,7) y el 0,2% uveítis (IC 95%: 0,1-1,4). La presencia de artritis psoriásica se asoció al sexo masculino (OR: 1,75 [0,98-2,98]) y a la duración de la psoriasis > 8 años (OR: 4,17; [1,84- 9,44]) respecto a < 4 años. El 73,1% presentó al menos un FRCV: tabaquismo (40,5%); obesidad (26,0%); dislipidemia (24,8%); hipertensión arterial (24,3%) y diabetes mellitus (12,3%). Conclusión: Los pacientes con psoriasis presentaron una prevalencia del 15,5% de otras EIMI, discretamente superior a la de población general. Casi tres cuartas partes tuvieron al menos un FRCV (AU)

Introduction and objectives: Patients with psoriasis often have comorbidities, including other immune-mediated inflammatory diseases (IMIDs), and cardiovascular risk factors. In this article we describe the baseline prevalence of comorbidities----including other IMIDs----in a cohort of patients with psoriasis. Patients and methods: AQUILES was a prospective observational multicenter study of 3 patient cohorts (patients with psoriasis, spondyloarthritis, or inflammatory bowel disease) undertaken to investigate the prevalence of comorbidities, including other IMIDs, in these settings. The psoriasis cohort comprised patients aged at least 18 years who were seen in hospital dermatology clinics. A predefined protocol was used to collect demographic and clinical data. Results: The study enrolled 528 patients with psoriasis (60.2% men and 39.8% women). Mean age was 46.7 years; 89.8% of the participants had plaque psoriasis, and the median Psoriasis Area Severity Index score (PASI) was 3.2 (1.5-7.4). Comorbid IMIDs were present in 82 (15.5%) of the patients (CI 95%, 12.7%-18.9%). Spondyloarthritis was observed in 14% of patients (95% CI, 11.3%-17.2%), mostly in the form of psoriatic arthritis, for which the overall prevalence was 13.1% (95% CI, 10.5%-16.2%). Inflammatory bowel disease was present in 1.3% (95% CI, 0.6%-2.7%) and uveitis in .2% (95% CI, 0.1%-1.4%). Psoriatic arthritis was associated with male sex (odds ratio, 1.75 [.98-2.98]) and a disease duration of over 8 years (OR, 4.17 [1.84-9.44] vs a duration of < 4 years). In 73.1%, at least 1 cardiovascular risk factor was identified: smoking (40.5%), obesity (26.0%), dyslipidemia (24.8%), hypertension (24.3%), and diabetes mellitus (12.3%). Conclusion: In patients with psoriasis the prevalence of other IMIDs was 15.5%, a level slightly higher than that found in the general population. Nearly three-quarters of these patients had at least 1 cardiovascular risk factor (AU)

[Perception of UCI nurses in relation with satisfactory care: convergences and divergences with the perception of critical patients]. / Percepción de las enfermeras de UCI en relación al cuidado satisfactorio: convergencias y divergencias con la percepción del paciente crítico.

OBJECTIVE: Explore convergences and divergences between perception of nurses and of critically ill patients, in relation to the satisfactory care given and received. METHODS: It is part of a larger qualitative study, according to the Grounded Theory. Carried out in 3 intensive care units with 34 boxes. Sampling theoretical profiles with n=19 patients and n=7 nurses after data saturation. Recruitment of patients included in the profiles of elderly and long-stay got stretched over some time due to the low incidence of cases. Data collection consisted of: in-depth interview to critically ill patients, group discussion of expert nurses in the critical care patient and field diary. Analysis themed on Grounded Theory according Strauss and Corbin: open coding, axial and selective. Analysis followed criteria of Guba and Lincoln rigor, Calderón quality and Gastaldo and McKeever ethical reflexivity. There was a favorable report from the ethical committee of the Hospital and informed consent of the participants. RESULTS: Four matching categories were found: professional skills, human, technical and continued care. Combination of these elements creates feelings of security, calmness and feeling like a person, allowing the patient a close and trusting relationship with the nurse who takes individualized care. Not divergent categories were found. CONCLUSIONS: Perceptions of nurses in relation to care match perceptions of critically ill patients in both the definition and dimensions upon satisfactory care.

Rotura de aneurisma iliaco durante el preacondicionamiento con levosimendán previo a cirugía de revascularización coronaria, ¿fue levosimendán el factor más influyente? / Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery graft, it was levosimendan the most influencing factor?

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Immune-mediated inflammatory diseases and other comorbidities in patients with psoriasis: baseline characteristics of patients in the AQUILES study.

INTRODUCTION AND OBJECTIVES: Patients with psoriasis often have comorbidities, including other immune-mediated inflammatory diseases (IMIDs), and cardiovascular risk factors. In this article we describe the baseline prevalence of comorbidities-including other IMIDs-in a cohort of patients with psoriasis. PATIENTS AND METHODS: AQUILES was a prospective observational multicenter study of 3 patient cohorts (patients with psoriasis, spondyloarthritis, or inflammatory bowel disease) undertaken to investigate the prevalence of comorbidities, including other IMIDs, in these settings. The psoriasis cohort comprised patients aged at least 18 years who were seen in hospital dermatology clinics. A predefined protocol was used to collect demographic and clinical data. RESULTS: The study enrolled 528 patients with psoriasis (60.2% men and 39.8% women). Mean age was 46.7 years; 89.8% of the participants had plaque psoriasis, and the median Psoriasis Area Severity Index score (PASI) was 3.2 (1.5-7.4). Comorbid IMIDs were present in 82 (15.5%) of the patients (CI 95%, 12.7%-18.9%). Spondyloarthritis was observed in 14% of patients (95% CI, 11.3%-17.2%), mostly in the form of psoriatic arthritis, for which the overall prevalence was 13.1% (95% CI, 10.5%-16.2%). Inflammatory bowel disease was present in 1.3% (95% CI, 0.6%-2.7%) and uveitis in .2% (95% CI, 0.1%-1.4%). Psoriatic arthritis was associated with male sex (odds ratio, 1.75 [.98-2.98]) and a disease duration of over 8 years (OR, 4.17 [1.84-9.44] vs a duration of < 4 years). In 73.1%, at least 1 cardiovascular risk factor was identified: smoking (40.5%), obesity (26.0%), dyslipidemia (24.8%), hypertension (24.3%), and diabetes mellitus (12.3%). CONCLUSION: In patients with psoriasis the prevalence of other IMIDs was 15.5%, a level slightly higher than that found in the general population. Nearly three-quarters of these patients had at least 1 cardiovascular risk factor.

Factores implicados en el desarrollo de vasoplejía tras cirugía cardiaca con circulación extracorpórea. Estudio prospectivo observacional / Factors involved in the development of vasoplegia after cardiac surgery with extracorporeal circulation. A prospective observational study

Objetivo. Investigamos la incidencia y los factores de riesgo asociados al desarrollo de vasoplejía en el postoperatorio inmediato y a las 24 h en pacientes sometidos a cardiocirugía con circulación extracorpórea. La mayoría de los factores de riesgo evidenciados provienen de estudios retrospectivos. Métodos. Entre noviembre de 2011 y mayo de 2012 estudiamos prospectivamente 188 pacientes consecutivos operados de cardiocirugía con circulación extracorpórea. Excluimos intervenciones quirúrgicas de urgencia y de alta complejidad. Evaluamos la vasoplejía en el postoperatorio inmediato y a las 24 h, definida como presiones arteriales medias inferiores a 50 mmHg y perfusión de noradrenalina superior a 0,08 μg/kg/min, monitorizadas con gasto cardiaco y resistencias vasculares sistémicas. Todos se sometieron al mismo protocolo anestésico, tratamiento hemodinámico y de circulación extracorpórea. Resultados. El 48% presentaron vasoplejía en el postoperatorio inmediato y un 34% a las 24 h. Los factores de riesgo para el desarrollo de vasoplejía fueron el uso de inhibidores de la enzima convertidora de la angiotensina, presentar una presión arterial media < 50 mmHg a la entrada en circulación extracorpórea, el tiempo de pinzamiento aórtico y la temperatura mínima durante la circulación extracorpórea. Y 24 h se correlacionó con el uso de inhibidores de la enzima convertidora de la angiotensina y el tiempo de circulación extracorpórea. Conclusión. La incidencia de vasoplejía en estos pacientes es elevada. El uso preoperatorio de inhibidores de la enzima convertidora de la angiotensina y la presión arterial media a la entrada de circulación extracorpórea son factores de riesgo potencialmente controlables, o si el paciente se presenta con ellos, prever el tratamiento o la prevención de la vasoplejía (AU)

Objective. The incidence and risk factors for vasoplegia in the early postoperative period and at 24 h are investigated in patients subjected to cardiopulmonary bypass surgery. Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. The risk factors described emerged from retrospective, non-controlled studies. Methods. Observational prospective study of 188 consecutive patients subjected to cardiac surgery with cardiopulmonary bypass in a single hospital between November 2011 and May 2012. Emergency surgery or complex procedures were excluded. Vasoplegia was assessed during the immediate postoperative period, and at 24 h after surgery, and was defined as a mean arterial pressure below 50 mmHg, and the need for a noradrenaline perfusion of more than 0.08 μg/kg/min, monitored by cardiac output and systemic vascular resistances. The anaesthetic and cardiopulmonary bypass protocols, as well as haemodynamic management, were the same in all patients. Results. Almost half (48%) of patients had vasoplegia in the immediate postoperative period, and 34% at 24 h. Risk factors for immediate vasoplegia development were preoperative use of angiotensin converting enzyme inhibitor drugs, a mean arterial pressure < 50 mmHg immediately after beginning cardiopulmonary bypass, duration of aortic clamping as well as the cardiopulmonary bypass, and minimum temperature in cardiopulmonary bypass. Vasoplegia at 24 h after surgery was correlated to preoperative angiotensin converting enzyme inhibitor drug treatment and cardiopulmonary bypass duration. Conclusion. The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. Preoperative treatment with angiotensin converting enzyme inhibitor and the mean arterial pressure at the beginning of cardiopulmonary bypass are the more easily controllable risk factors. In patients arriving to surgery with those drugs, treatment or prevention of vasoplejia should be planned (AU)

[Factors involved in the development of vasoplegia after cardiac surgery with extracorporeal circulation. A prospective observational study]. / Factores implicados en el desarrollo de vasoplejía tras cirugía cardiaca con circulación extracorpórea. Estudio prospectivo observacional.

OBJECTIVE: The incidence and risk factors for vasoplegia in the early postoperative period and at 24h are investigated in patients subjected to cardiopulmonary bypass surgery. Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. The risk factors described emerged from retrospective, non-controlled studies. METHODS: Observational prospective study of 188 consecutive patients subjected to cardiac surgery with cardiopulmonary bypass in a single hospital between November 2011 and May 2012. Emergency surgery or complex procedures were excluded. Vasoplegia was assessed during the immediate postoperative period, and at 24h after surgery, and was defined as a mean arterial pressure below 50mmHg, and the need for a noradrenaline perfusion of more than 0.08µg/kg/min, monitored by cardiac output and systemic vascular resistances. The anaesthetic and cardiopulmonary bypass protocols, as well as haemodynamic management, were the same in all patients. RESULTS: Almost half (48%) of patients had vasoplegia in the immediate postoperative period, and 34% at 24h. Risk factors for immediate vasoplegia development were preoperative use of angiotensin converting enzyme inhibitor drugs, a mean arterial pressure<50mmHg immediately after beginning cardiopulmonary bypass, duration of aortic clamping as well as the cardiopulmonary bypass, and minimum temperature in cardiopulmonary bypass. Vasoplegia at 24h after surgery was correlated to preoperative angiotensin converting enzyme inhibitor drug treatment and cardiopulmonary bypass duration. CONCLUSION: The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. Preoperative treatment with angiotensin converting enzyme inhibitor and the mean arterial pressure at the beginning of cardiopulmonary bypass are the more easily controllable risk factors. In patients arriving to surgery with those drugs, treatment or prevention of vasoplejia should be planned.

Pharmacological and neuroethological studies of three antiepileptic drugs in the Genetic Audiogenic Seizure Hamster (GASH:Sal).

Epilepsy modeling is essential for understanding the basic mechanisms of the epileptic process. The Genetic Audiogenic Seizure Hamster (GASH:Sal) exhibits generalized tonic-clonic seizures of genetic origin in response to sound stimulation and is currently being validated as a reliable model of epilepsy. Here, we performed a pharmacological and neuroethological study using well-known and widely used antiepileptic drugs (AEDs), including phenobarbital (PB), valproic acid (VPA), and levetiracetam (LEV). The intraperitoneal administration of PB (5-20mg/kg) and VPA (100-300mg/kg) produced a dose-dependent decrease in GASH:Sal audiogenic seizure severity scores. The administration of LEV (30-100mg/kg) did not produce a clear effect. Phenobarbital showed a short plasmatic life and had a high antiepileptic effect starting at 10mg/kg that was accompanied by ataxia. Valproic acid acted only at high concentrations and was the AED with the most ataxic effects. Levetiracetam at all doses also produced sedation and ataxia side effects. We conclude that the GASH:Sal is a reliable genetic model of epilepsy suitable to evaluate AEDs.

La percepción del paciente crítico sobre los cuidados enfermeros: una aproximación al concepto de satisfacción / Perception of the critical patient on nursing cares: an approach to the concept of satisfaction

Introducción El grado de satisfacción es un indicador fundamental de la calidad asistencial. Existen numerosos instrumentos que miden la satisfacción con los cuidados enfermeros, aunque no responden a la realidad del paciente crítico ni a nuestro contexto. Objetivos Explorar y comprender la satisfacción de los pacientes ingresados en Cuidados Intensivos de un hospital nivel iii con los cuidados enfermeros, para definir e identificar las dimensiones del concepto de satisfacción desde su punto de vista. Material y métodos Estudio cualitativo según la teoría fundamentada en 3 unidades de Cuidados Intensivos de 34 boxes individuales. Muestreo teórico. La muestra, tras la saturación de datos, fue de 19 participantes. La recogida de datos fue a través de la entrevista en profundidad y diario de campo. Análisis de contenido según teoría fundamentada. Se siguieron los criterios de rigor de Guba y Lincoln. Informe favorable del comité de ética del centro y consentimiento informado. Resultados Emergen 4 categorías: definición y dimensiones del concepto de satisfacción, expectativas y vivencias. Los participantes incluyen en su definición de satisfacción las dimensiones: competencias profesionales, cuidados humanos, técnicos y continuados. La combinación de estos elementos produce sentimientos de seguridad, tranquilidad, estar vigilado, sentirse persona, percibiendo una relación cercana y de confianza con la enfermera que realiza cuidados individualizados. Conclusiones La definición y las dimensiones del concepto de satisfacción desde el punto de vista del paciente muestran los aspectos importantes para la persona además de clarificar sus dimensiones, permitiendo la construcción de instrumentos más acordes con el contexto y su percepción real (AU)

Introduction Level of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context. Objectives To define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view. Material and methods A qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients. Results Four categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares. Conclusions The definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception (AU)

Bloqueo paravertebral continuo para analgesia en cirugía cardiaca mínimamente invasiva / Continuous paravertebral block for analgesia in minimally invasive cardiac surgery

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