Protocolos de estimulación ovárica en inseminación artificial según el patrón utilizado de glicosilación de la hormona folículo estimulante / The impact of different ovarian stimulating protocols in artificial insemination based on the glycosylation pattern of the follicle stimulating hormone

Resumen ANTECEDENTES: los estudios clínicos que comparan diferentes protocolos de estimulación ovárica no son concluyentes. Nuestro estudio compara tres protocolos según el patrón de glicosilación de la hormona folículo estimulante (FHS) que imita el ciclo natural para inseminación artificial. OBJETIVO: proponer un protocolo de estimulación ovárica secuencial con FSH urinaria (isoforma ácida) seguido de FSH recombinante (isoforma menos ácida) y evaluar su efectividad respecto de los esquemas tradicionales de estimulación con FSH recombinante (FSHr) y FSH urinaria (FSHu). MATERIALES Y MÉTODOS: estudio de cohortes, retrospectivo, efectuado entre mayo de 2012 y mayo 2015 en parejas infértiles en protocolo de inseminación artificial. El grupo de estudio se dividió en tres: 1) FSHr, 2) FSHhp y 3) estimulación sequencial: FSHhp + FSHr. Para el análisis estadístico se utilizaron χ2, ANOVA o test Mann-Whitney. Los resultados se reportan con límite de significación de p < 0.05. RESULTADOS: se estudiaron 178 parejas infértiles en protocolo de inseminación artificial y se efectuaron 299 ciclos de estimulación ovárica con inseminación artificial; grupo 1) 99 con FSHr, 2)100 con FSHhp y 3) 100 con estimulación sequencial: FSHhp + FSHr. Los resultados gestacionales fueron mayores en el grupo FSHu y secuencial. En el análisis costo-efectividad se observó menor tasa con el esquema secuencial en comparación con los otros dos. Al comparar los tres protocolos según los intentos previos de inseminación, en la serie con intentos previos, se encontraron diferencias estadísticamente significativas en βHCG y gestación al comparar FSHr versus secuencial. El protocolo FSHr fue menos efectivo que los otros dos tratamientos. CONCLUSIONES: se planteó la estimulación ovárica controlada con protocolo secuencial en pacientes que recibirían inseminación artificial y, aunque no se encontraron diferencias significativas, sí se observó una tendencia en la que tanto la dosis como los días de estimulación requerida son menores con este protocolo que con los clásicos con FSHr o FSHu.

Abstract BACKGROUND: Earlier trials comparing different ovarian stimulating protocols in assisted reproduction found no significant differences in the results. OBJECTIVE: To evaluate the effect of three different stimulation protocols based on the glycosylation pattern of the follicle stimulating hormone (FSH) in an intrauterine insemination (IUI) program. The stimulating protocols are: human FSH (acidic isoform), recombinant FSH (less acidic isoform) and combined urinary and recombinant FSH. MATERIALS AND METHODS: Cohort study, retrospective, conducted between May 2012 and May 2015 in infertile couples in protocol of artificial insemination. The study group was divided into three: 1) FSHr, 2) FSHhp and 3) sequential pacing: FSHhp + FSHr. For statistical analysis, χ2, ANOVA or Mann-Whitney test were used. The results are reported with a significance limit of p < 0.05. RESULTS: 178 infertile couples were studied in an artificial insemination protocol and 299 cycles of ovarian stimulation were performed with artificial insemination; Group 1) 99 with FSHr, 2) 100 with FSHhp and 3) 100 with sequential stimulation: FSHhp + FSHr. CONCLUSION: In this study, controlled ovarian stimulation with sequential protocol was considered in patients who would receive artificial insemination and, although no significant differences were found, a trend was observed in which both the dose and the days of stimulation required are lower with this protocol than with the classics with FSHr or FSHu.

Enfermedad pulmonar obstructiva crónica. ¿Los tiempos están cambiando? / Chronic obstructive pulmonary disease. Are the times changing?

La enfermedad pulmonar obstructiva crónica (EPOC) es una de las afecciones más prevalentes, y que provoca mayor morbimortalidad en nuestro país. En la actualidad la EPOC se considera una afección tratable, de origen inflamatorio y frecuentemente asociada a otras enfermedades, cuya prevalencia está claramente aumentada en los pacientes con EPOC, independientemente de otras variables de confusión como el tabaquismo. Los tratamientos actuales han demostrado frenar la pérdida de función pulmonar, disminuir el número de exacerbaciones, mejorar la calidad de vida relacionada con la salud y prolongar la supervivencia. La recuperación de los fenotipos clásicos y de otros nuevos como el de los pacientes con exacerbaciones frecuentes o el de EPOC con comorbilidad asociada, deberían permitirnos individualizar los tratamientos, al mismo tiempo que los avances en investigación genética y de los mecanismos inflamatorios nos permitirán conocer mejor la enfermedad y añadir nuevas terapias a las ya existentes(AU)

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases and a major cause of morbidity and mortality in Spain. Currently, COPD is considered a treatable disease with an inflammatory origin that is frequently associated with other diseases. The prevalence of comorbidity is clearly increased in patients with COPD, irrespective of other confounding variables such as smoking. Current treatments have been proven to slow the loss of lung function, decrease the number of exacerbations and improve health-related quality of life and survival. New advances regarding the classics and more recent phenotypes such as patients with frequent exacerbations or COPD with associated comorbidity should allow for more individualized treatment while advances in genetic research and inflammatory mechanisms of the disease will help us to increase our knowledge of the disease and the development of new treatments(AU)

Chronic obstructive pulmonary disease. Are the times changing?

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases and a major cause of morbidity and mortality in Spain. Currently, COPD is considered a treatable disease with an inflammatory origin that is frequently associated with other diseases. The prevalence of comorbidity is clearly increased in patients with COPD, irrespective of other confounding variables such as smoking. Current treatments have been proven to slow the loss of lung function, decrease the number of exacerbations and improve health-related quality of life and survival. New advances regarding the classics and more recent phenotypes such as patients with frequent exacerbations or COPD with associated comorbidity should allow for more individualized treatment while advances in genetic research and inflammatory mechanisms of the disease will help us to increase our knowledge of the disease and the development of new treatments.

Prevalence of thoracic vertebral fractures in Spanish patients hospitalized in Internal Medicine Departments. Assessment of the clinical inertia. (PREFRAMI study).

PURPOSE: To study the prevalence of vertebral fractures (VF), the associated risk factors and the degree of diagnosis and prescription upon discharge in a series of hospitalized medical patients ≥50 years of age. METHODS: A cross-sectional, multicentre and observational study in which a prevalence cut-off was carried out concerning patients admitted to six Internal Medicine departments in Malaga (Spain). The main variables were the existence of a fracture in the spine lateral x-ray, the inclusion of the diagnosis of a fracture in the discharge report, and the establishment of anti-osteoporotic treatment at discharge. RESULTS: 254 patients were included (mean age 66.4±14.9 years). The prevalence of VF was of 14.2% (36 cases). Patients with VF presented with a higher mean age, compared to those without VF (70.14 vs. 65.7 years) (p=0.035). The means contrast for the FRAX index variable (major osteoporotic and hip fracture), grouping according to the presence of VF, did not show any statistical significance (p=0.369 and p=0.788, respectively). Only in 8.3% of the discharge reports of patients with VF had the diagnosis of VF and/or osteoporosis been recorded and the prescription of anti-osteoporotic drugs been included. CONCLUSIONS: A high prevalence of asymptomatic VF is verified in medical inpatients ≥50 years of age. The FRAX index did not turn out to be predictive of the presence of VF in this population. There is an underdiagnosis of osteoporotic VF in the coding at hospital discharge. Action protocols are necessary to avoid clinical inactivity regarding this entity.

Clinical accuracy of a non-contact infrared skin thermometer in paediatric practice.

BACKGROUND: Rectal thermometry is considered the most reliable method for measuring the temperature in the paediatric population. Recently, a new non-contact skin infrared thermometer for children was introduced in the market with excellent acceptance by parents. METHODS: A prospective, analytical, cross-sectional study was designed in order to assess the effectiveness of the infrared non-contact thermometer (Thermofocus) in comparison with two other known methods used to measure body temperature. Children aged 1 to 48 months were included from the emergency room and inpatient unit. All patients selected were assessed with three different thermometers: (1) non-contact infrared thermometer (Thermofocus); (2) temporal artery thermometer (Exergen); and (3) rectal glass mercury thermometer. RESULTS: Four hundred and thirty-four patients were eligible to complete the study. One hundred and sixty-seven were identified with fever. The mean age of the patients studied was 14.6 ± 10.7 months. Both devices were strongly correlated with the rectal temperature: r = 0.950 for Exergen and r = 0.952 for Thermofocus. The mean difference in temperature between the rectal temperature and the non-contact thermometer was 0.029 ± 0.01 °C (P < 0.001), while the mean difference between the temporal artery thermometer and the rectal temperature was -0.20 ± 0.27 °C (P < 0.001). The sensitivity and specificity for the non-contact thermometer is 97%. The negative predictive value is 99%, which is especially important to rule out fever and avoid unnecessary laboratory work-up. CONCLUSIONS: The non-contact infrared thermometer is a reliable, comfortable and accurate option for measurement of temperature and is very useful for the screening of fever in the paediatric population. More studies are recommended to support the evidence found in this study and compare its accuracy with more complex devices.

Estilos de aprendizaje de estudiantes de medicinaen universidades latinoamericanas y españolas: relación con los contextos geográficos y curriculares / Medical students learning styles in Latin American and Spanish universities: relation with geographical and curricular contexts

Objetivo. Determinar si los estilos de aprendizaje (EA)de los estudiantes de medicina se correlacionan con el contexto geográfico, con el contexto curricular o con el nivel de la carrera. Sujetos y métodos. El estudio se realizó en 490 estudiantes de las Escuelas de Medicina de las Universidades de Chile (Santiago, Chile), Nacional de Cuyo (Mendoza, Argentina), San Francisco Xavier (Sucre,Bolivia), Zaragoza y País Vasco (España). Se aplicó el cuestionario Honey-Alonso, que valora la preferencia por cada uno de cuatro EA: activo, reflexivo, teórico y pragmático. También se evaluó el EA de acuerdo al modelo de Kolb. Resultados. Al relacionar el EA con el contexto geográficos observó que mientras los estudiantes de universidades españolas muestran un estilo preferentemente asimilador, siguiendo la denominación de Kolb, para Chile fue el acomodador y para Bolivia los estudiantes se distribuyen entre los estilos asimilador y divergente. Al comparar la distribución de los EA durante el tercer curso de medicina en dos facultades que poseen diferente currículo, no se observaron diferencias significativas. Los EA en una Facultad de Medicina con un currículo basado en asignaturas(Chile) no mostraron diferencias en los tres cursos del estudio(1.º, 3.º y 5.º), siendo preferentes los estilos reflexivo y teórico. Conclusiones. El estudio permitió establecer diferencias significativas entre los estilos de aprendizaje de los estudiantes de Medicina en relación con el contexto geográfico, más que con los diferentes currículos, o a lo largo de los distintos cursos de la carrera (AU)

Aim. To establish a correlation between medical student learning styles (LS) and the geographical context, the curricular context and different academic levels. Subjects and methods. The study was performed in 490 undergraduate students from Medical Schools of the Universities of Chile (Santiago, Chile),Nacional de Cuyo (Mendoza, Argentina), San Francisco Xavier(Sucre, Bolivia), Zaragoza and País Vasco (Spain). The instrument used was the Honey-Alonso learning style questionnaire that assesses the student preference for one of four LS: active, reflexive, theoretic and pragmatic. In addition, LS according to the Kolb inventory were also assessed. Results. Using the Kolb inventory, significant differences were found when the LS were correlated with the geographical context. While Spanish students showed a high preference for the assimilator style of learning, Chilean students resulted to be mainly accommodators, and Bolivian students were both assimilators and divergent. Comparing the LS distribution during the third course in two universities with different curricula (problem and lecture based learning), there were no significant differences. LS of medical students from a Medical School with a lecture based curriculum (University of Chile) were not significantly different during the first, the third and the fifth level of their undergraduate students. They showed a significant preference for reflexive and theoretic styles of learning. Conclusions. The present study allowed demonstrating that significant differences among the styles of learning of medical students correlated with the geographical context more than with the different curricula, or along the different courses of the career (AU)

[First case of sacral neuromodulation for treatment of urinary and fecal incontinence in Mexico. Case report.]. / Primer caso de neuromodulación sacrapara el tratamiento de la incontinenciaurinaria y fecal en México. Informe de caso.

Sacral neuromodulation is a new treatment for urinary and fecal incontinence that has demonstrated good therapeutic results. This treatment modality has shown not only to reduce urinary dysfunction symptoms and urinary and fecal incontinence but improve quality of life scores as well. We present a 73 years old female patient with severe fecal and urinary incontinence with major quality of life impact. She was referred after failure of different surgical and conservative therapeutic approaches. Her evaluation met inclusion criteria for sacral neuromodulation treatment. Acute sacral nerve evaluation (PNE) proved to be therapeutic in the patient as measured by at least a 50 percent improvement in her symptoms so a permanent implant (Medtronic InterStim System) was placed. After the implant there was a significant improvement in urinary and fecal functional scores. Fecal Incontinence Severity Index improved from 34 to 8 and Urinary Sandvik's Severity Index from very severe urinary incontinence to minor urinary incontinence after the placement of the implant. Using standard quality of life questionnaires, she improved in the areas of lifestyle,coping and behavior and her experience with depression and self-perception.

Hernia de Bochdalek: caso clínico / Bochdalek hernia: clinical case

La Hernia Diafragmática es la penetración de una o más visceras abdominales en el tórax, a trvés de un orificio normal o anormal del diafragma. Se han descrito 4 formas diferentes de hernias diafragmáticas congénitas: Hernia de Hiato, Hernia paraesofágica, Hernia de Morgagni-Larrey y Hernia de Bochdalek, así como también se han descrito Hernias diafragmáticas post-traumáticas. La Hernia de Bochdalek (posterolateral) es el resultado de un defecto diafragmático congénito en la parte costal posterior del diafragma, en la región de las costillas X y XI. Es una patología frecuente en el recién nacido y rara en el adulto. En la revisión de la literatura mundial encontramos 100 casos reportados en el adulto. Suele haber una comunicación libre entre las cavidades torácica y abdominal. Este defecto es más frecuente (90 por ciento) en el lado izquierdo, aunque puede producirse en el lado derecho, donde el hígado a menudo impide su diagnóstico. Es dos veces más frecuente en el varón. Presentamos el caso de una paciente femenina de 76 años, quién ingresó con dificultad para respirar y dolor torácico, desde hace (04) meses, se constata en el hemitórax izquierdo ruidos respiratorios abolidos con ruidos hidroaéreos presentes. Se realizan métodos diagnósticos a través de imágenes y se confirma evidente desplazamiento apical de estructuras retroperitoneales, riñón y asas intestinales hacia el hemitórax izquierdo. Se le realizó toracotomía izquierda, posterolateral, nefrectomía izquierda y afrontamiento de defecto diafragmático. Se realiza la revisión de dicha patología.

Prevalence of insulin resistance and its association with metabolic syndrome criteria among Bolivian children and adolescents with obesity.

BACKGROUND: Obesity is a one of the most common nutritional disorder worldwide, clearly associated with the metabolic syndrome, condition with implications for the development of many chronic diseases. In the poorest countries of Latin America, malnourishment is still the most prevalent nutritional problem, but obesity is emerging in alarming rates over the last 10 years without a predictable association with metabolic syndrome. The objective of our study was to determine the association between insulin-resistance and components of the metabolic syndrome in a group of Bolivian obese children and adolescents. The second objective was determining the relation of acanthosis nigricans and insulin-resistance. METHODS: We studied 61 obese children and adolescents aged between 5 and 18 years old. All children underwent an oral glucose tolerance test and fasting blood sample was also obtained to measure insulin, HDL, LDL and triglycerides serum level. The diagnosis of metabolic syndrome was defined according to National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III) criteria adapted for children. RESULTS: Metabolic syndrome was found in 36% of the children, with a higher rate among males (40%) than females (32.2%) (p = 0.599). The prevalence of each of the components was 8.2% in impaired glucose tolerance, 42.6% for high triglyceride level, 55.7% for low levels of high-density lipoprotein cholesterol, and 24.5% for high blood pressure. Insulin resistance (HOMA-IR > 3.5) was found in 39.4% of the children, with a higher rate in males (50%) than females (29%). A strong correlation was found between insulin resistance and high blood pressure (p = 0.0148) and high triglycerides (p = 0.002). No statistical significance was found between the presence of acanthosis nigricans and insulin resistance. CONCLUSION: Metabolic syndrome has a prevalence of 36% in children and adolescent population in the study. Insulin resistance was very common among children with obesity with a significant association with high blood pressure and high triglycerides presence.

Analysis of 27,248 hospital discharges for heart failure: a study of an administrative database 1998-2002.

AIMS: To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM). METHODS AND RESULTS: Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures. There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r(2) = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001). The global in-hospital mortality rate was 11.1% and we found differences between Cardiology and MI. MI patients were older (74 years compared to 69, p < 0.0001), had greater comorbidity, a similar length of stay (11.1 days), and a lower number of coded diagnostic procedures. Associated pathologies were different. Seasonal variation is clear. CONCLUSION: The incidence of discharges for heart failure is high and steadily increasing, although this is more evident in IM. The populations attended by the two services are different, which makes it difficult to ascertain differences in handling. The results are slightly different from those reported in other countries.

Analysis of 27, 248 hospital discharges for heart failure: a study of an administrative database 1998-2002

Objetivos. Conocer la epidemiología de lahospitalización por insuficiencia cardiaca (IC) enlos hospitales de Andalucía (España). Definir elperfil de los pacientes asistidos en MedicinaInterna (MI).Métodos y resultados. Análisis del ConjuntoMínimo Básico de Datos (CMBD) de los 32hospitales públicos de Andalucía (España) durante1998-2002, identificando los casos con diagnósticoprincipal o secundario de IC analizando edad, sexo,estancia, estacionalidad, destino, número dediagnósticos, GDR, procedimientos codificados. Seprodujeron 2.787.008 altas, 27.248 de ICC,(15.737 MI, 7.735 Cardiología y 3.776 otrosservicios). Las altas por IC crecieron desde 1998 a2003 (r2 = 0,7232). El 44% fueron hombres conedad media de 70,98 años (IC 95% 70,08-70,47) yel 56% mujeres con 74,77 (IC 95% 74,61-74,93)(p<0,0001). La tasa de mortalidad intrahospitalariaglobal fue del 11,1% y encontramos diferenciasentre Cardiología y MI. Los pacientes queingresaron en MI tenían mayor edad (74 años frentea 69, p<0,0001), mayor comorbilidad, estanciamedia similar (11,1 días) y menor número deprocedimientos diagnósticos codificados. Lapatología asociada fue diferente. La estacionalidades evidente.Conclusión. La incidencia de IC es elevada yaumenta progresivamente, aunque más en MI.Las poblaciones de uno y otro servicio sondiferentes, por lo que es difícil asegurar diferenciasde manejo. Los resultados difieren ligeramente delos comunicados en otros países

Aims. To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM).Methods and results. Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures.There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r2 = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001).The global in-hospital mortality rate was 11.1% andwe found differences between Cardiology and MI.MI patients were older (74 years compared to 69,p < 0.0001), had greater comorbidity, a similarlength of stay (11.1 days), and a lower number ofcoded diagnostic procedures. Associated pathologieswere different. Seasonal variation is clear.Conclusion. The incidence of discharges for heartfailure is high and steadily increasing, although thisis more evident in IM. The populations attended bythe two services are different, which makes itdifficult to ascertain differences in handling. Theresults are slightly different from those reported inother countries

[Internal Medicine hospital departments of Andalucian Public Health System. A description of the clinical activity in 2002]. / Servicios hospitalarios de Medicina Interna. Una descripción de la actividad en el Sistema Público de Andalucía en 2002.

BACKGROUND: Description of the patients admitted in the general Internal Medicine (IM) departments of the Public Health System in Andalusia (Spain) (PHSA) during 2002. PATIENTS AND METHODS: It is an analysis of the Minimum Basic Set of Data (MBSD) and its management by the Diagnostic Related Groups (DRG) of admission episodes in Andalusian public hospitals. We divided the hospitals into group 1: more than 600 beds; group 2: between 200 and 600 beds, and group 3: less than 200 beds. RESULTS: IM services discharged 80,514 patients (total in PHSA, 558,114); 25.9%, 29.6% and 44.5% from groups 1, 2 y 3, respectively; 87.4% were admitted from the emergency room. Gross mortality rate was 10.23%. Average age was 72 years, 8 years more than in the other medical departments. Mean diagnosis per episode was 5.4. The most frequent pathologies (33%) were chronic obstructive pulmonary disease, congestive heart failure, brain stroke and coronary heart disease. Adjusted length of stay was 9.35 days, this being somewhat longer in big hospitals. Mean weight of the episodes (DRG weight) of IM services was 20% higher than the mean of the rest and it accumulates 18.02% of the total weight. Real hours of outpatient clinics was 5.45% of the total. CONCLUSIONS: The activity of the general IM services is very high in relative and absolute terms. Higher age and the multiple pathologies are typical characteristics of IM patients in Andalusia. Author claim it is very important to be careful with the clinical and administrative records. Interventions on prevalent diseases in IM services may produce positive and valuable results due to their high volume.

Servicios hospitalarios de Medicina Interna. Una descripción de la actividad en el Sistema Público de Andalucía en 2002 / Internal Medicine hospital departments of Andalucian Public Health System. A description of the clinical activity in 2002

Fundamento. Estudio descriptivo de la patología de los servicios y/o Unidades de Medicina Interna (SSMI) del Sistema Sanitario Público de Andalucía (SSPA) en el año 2002. Material y método. Análisis del Conjunto Mínimo Básico de Datos (CMBD) y su agrupación en Grupos Relacionados por el Diagnóstico (GRD) de los episodios de ingreso en los hospitales públicos andaluces. Grupo 1: > 600 camas; grupo 2: 200 a 400, y grupo 3: < 200. Año 2002. Resultados. Los SSMI dieron 80.514 altas (total, 558.114); 25,9%, 29,6% y 44,5% de los grupos 1, 2 y 3, respectivamente. El 87,4% ingresó desde urgencias. La tasa de mortalidad bruta fue del 10,23%. La mediana de la edad 72 años, superior en más de 8 años al resto de los servicios del área médica. La media de diagnósticos por episodio fue de 5,4. Las patologías más frecuentes: EPOC, insuficiencia cardíaca, ictus cerebral y cardiopatía isquémica supusieron un tercio de los casos. La estancia media depurada fue de 9,35 días; algo mayor en los hospitales grandes. El peso medio de los episodios (peso GRD) fue un 20% superior al resto de servicios y acumula el 18,02% del peso total. Las horas de consulta externa acreditadas fueron un 5,45% del total. Discusión. La actividad desarrollada en los SSMI es, en términos relativos y absolutos, muy elevada. La edad superior y la pluripatología son características del perfil tipo de MI. Se considera altamente prioritario el rigor en la elaboración de los registros. Las intervenciones sobre patologías prevalentes en los SSMI pueden dar resultados positivos evidentes por su gran volumen

Background. Description of the patients admitted in the general Internal Medicine (IM) departments of the Public Health System in Andalusia (Spain) (PHSA) during 2002. Patients and methods. It is an analysis of the Minimum Basic Set of Data (MBSD) and its management by the Diagnostic Related Groups (DRG) of admission episodes in Andalusian public hospitals. We divided the hospitals into group 1: more than 600 beds; group 2: between 200 and 600 beds, and group 3: less than 200 beds. Results. IM services discharged 80,514 patients (total in PHSA, 558,114); 25.9%, 29.6% and 44.5% from groups 1, 2 y 3, respectively; 87.4% were admitted from the emergency room. Gross mortality rate was 10,23%. Average age was 72 years, 8 years more than in the other medical departments. Mean diagnosis per episode was 5.4. The most frequent pathologies (33%) were chronic obstructive pulmonary disease, congestive heart failure, brain stroke and coronary heart disease. Adjusted length of stay was 9.35 days, this being somewhat longer in big hospitals. Mean weight of the episodes (DRG weight) of IM services was 20% higher than the mean of the rest and it accumulates 18.02% of the total weight. Real hours of outpatient clinics was 5.45% of the total. Conclusions. The activity of the general IM services is very high in relative and absolute terms. Higher age and the multiple pathologies are typical characteristics of IM patients in Andalusia. Author claim it is very important to be careful with the clinical and administrative records. Interventions on prevalent diseases in IM services may produce positive and valuable results due to their high volume

GETAWAY descriptors to predicting A(2A) adenosine receptors agonists.

The GEometry, Topology and Atom-Weights AssemblY approach has been applied to the study of the A(2A) adenosine receptors agonist effect of 29 adenosine analogues: N(6)-arylcarbamoyl, 2-arylalkynyl-N(6)-arylcarbamoyl, and N(6)-carboxamido derivatives. A model able to describe more than 77% of the variance in the experimental activity was developed with the use of the mentioned approach. In contrast, no one of four different approaches, including the use of Topological, Galvez Topological Charges indexes, Geometrical and WHIM descriptors were able to explain more than 70% of the variance in the mentioned property with the same number of variables in the equation.

[Poor scientific behavior in communication of biomedical results]. / Mala conducta científica en la comunicación de resultados biomédicos, costumbre consagrada por el uso o laxitud de la ética?

INTRODUCTION: The generically known as poor scientific behavior exists in different degrees with regard to biomedical communications and publications. From authentic fraud in the data up to the called "tricks" for curriculum fattening. MATERIAL AND METHODS: The objective of this work is to review the works presented in the XVIII Congress of the Andalusian Society of Internal Medicine (Marbella, October 2001), comparing them with the abstracts books of six more scientific meetings and congresses both regional and national. RESULTS: Of the 183 works evaluated in this review, 22 (12.02%) were doubled and 13 (7.10%) fragmented, in other words, a total of 35 (19.33%). The groups that presented communications were 36, and 17 of them (47.22%) carried out one or both fraudulent tactics. CONCLUSIONS: Despite the little bibliographic reference, in our environment exists the duplication and the fragmentation of works presented, in general as a system for curriculum increase. We advocate a higher clarity and commitment in the relationship between editors and authors, and an upsurge of the aspects of punishable deontological regulation on the one hand and of the ethics or a priori commitment on the other one.

Synthesis of carbocyclic analogues of MECA and NECA 1,2-disubstituted as potential adenosine receptor agonists.

A new class of 1,2-disubstituted carbocyclic nucleosides of MECA and NECA analogues was synthesized in good yield starting from (+/-) 6-azabicyclo[3.2.0]heptan-7-one.