Gender perspective in the implementation of hygiene in cardiology intensive care.

INTRODUCTION: Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS: Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS: Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION: Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

Mitral valve-in-valve implantation: A case report.

INTRODUCTION: Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. CASE DESCRIPTION: A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. ASSESSMENT: The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern 2: bilateral malleolar oedema without pitting; pattern 3: urinary catheter and intravenous diuretic use; pattern 4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern 5: need for pharmacological assistance for a good night's rest. DIAGNOSES: The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; ineffective breathing pattern; Activity intolerance and problem collaborating: Hypotension and anaemia secondary to deep thigh haematoma. PLANNING: The following objectives were set based on the NOC taxonomy: Fluid balance; Respiratory status: ventilation; Cardiopulmonary status and the following NIC interventions: Hypervolaemia management; Respiratory monitoring and oxygen therapy; Vital sign monitoring and heart care. DISCUSSION: Nursing interventions aimed at monitoring haemodynamic status, fluid restriction together with the efficacy of diuretic treatment achieved a negative water balance which contributed to fluid depletion improving respiratory symptoms, enabling implantation under better conditions. CONCLUSIONS: Technological progress in the health sciences, and in the field of acute cardiology in particular, directly calls for training, revision and updating of critical care nursing. Given this dynamic and continually evolving process, the specialist intensive care nurse, the inclusion of the cardiovascular nurse specialist in multidisciplinary teams such as the heart team, and expanding the consultation of the haemodynamic nurse are urgently required to ensure optimal nursing care, safety, and care quality.

Valve in valve mitral: a propósito de un caso / Mitral valve-in-valve implantation: A case report

Introducción: El implante valve in valve mitral es una nueva herramienta terapéutica que ha surgido recientemente en el campo del intervencionismo estructural en cardiología para pacientes con disfunción bioprotésica por insuficiencia mitral severa y alto riesgo quirúrgico. El objetivo es elaborar un plan de cuidados enfermero individualizado destinado a una paciente que se somete a este procedimiento, siendo el primer caso en nuestro centro. Descripción del caso: Mujer de 75años, independiente para las actividades de la vida diaria, con antecedentes de insuficiencia renal crónica y recambio valvular mitral biológico por valvulopatía reumática. Ingresada en la unidad de cuidados cardiológicos agudos por insuficiencia mitral severa sintomática secundaria a disfunción de la bioprótesis mitral. Descartada para cirugía cardíaca por comorbilidades y alto riesgo quirúrgico, se procedió al valve in valve mitral percutáneo, siendo exitoso su implante. Valoración: La valoración enfermera se realizó siguiendo el modelo conceptual de Marjory Gordon, donde se identificaron los siguientes patrones alterados: patrón2: edemas maleolares bilaterales sin fovea; patrón3: sondaje vesical y uso de diurético intravenoso; patrón4: disnea a moderados esfuerzos, tos seca nocturna, ortopnea y alteraciones respiratorias e intolerancia a la actividad; patrón5: necesidad de ayuda farmacológica para el buen descanso nocturno. Diagnósticos: Mediante la taxonomía NANDA se establecieron los diagnósticos enfermeros: Exceso de volumen de líquidos; Patrón respiratorio ineficaz; Intolerancia a la actividad y el problema de colaboración: Hipotensión y anemización secundaria al hematoma profundo en muslo.(AU)

Introduction: Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. Case description: A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. Assessment: The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern2: bilateral malleolar oedema without pitting; pattern3: urinary catheter and intravenous diuretic use; pattern4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern5: need for pharmacological assistance for a good night's rest.Diagnoses: The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; Ineffective breathing pattern; Activity intolerance and problem collaborating; Hypotension and anaemia secondary to deep thigh haematoma.(AU)

Evolución de la herida quirúrgica en pacientes intervenidos de artroplastia total de rodilla en los que se utilizaron cuatro tipos de apósitos distintos / Evolution of the surgical wound in patients undergoing total knee replacement surgery, using four different types of wound dressing

Objetivo: valorar la evolución de la herida quirúrgica en pacientes intervenidos de artroplastia total de rodilla en los que se utilizaron cuatro tipos de apósitos distintos.Método: estudio observacional a pacientes quirúrgicos de artroplastia de rodilla de la Unidad de Cirugía Ortopédica de Rodilla del Hospital Clínic (Barcelona). El primer día postcirugía, la enfermera curaba la herida quirúrgica (HQ) y colocaba un apósito, de los cuatro usados para el estudio. Los apósitos se distribuyeron en grupos de pacientes de 25. Se valoró el tiempo de permanencia del apósito, aparición de complicaciones (flictena, dehiscencia, exudado), confort por parte del paciente y facilidad en la colocación por parte de la enfermera. Las medidas de evaluación se tomaron a los siete días postcirugía en el momento de la cura en consultas externas. Se realizó un análisis descriptivo, con frecuencias, media y desviación estándar (DE).Resultados: se reclutaron 100 pacientes. El tiempo medio (DE) de permanencia fue superior en el Apósito 1 6,34 (1,56). Las complicaciones de HQ fueron menores en Apósito 4 (1 flictena, ninguna dehiscencia). El exudado moderado/abundante de HQ fue menor en Apósitos 1 y 4 (16% en ambos casos). La enfermera valoró facilidad en la colocación del Apósito 1, 2 y 4, en el 100% de pacientes. Los pacientes con mayor confort fueron los del grupo Apósito 1 (96%), aportando peor valoración los sujetos del grupo Apósito 4 (76%).Conclusiones: los apósitos 1 y 4 han mostrado un número mayor de ítems favorables (tiempo permanencia, facilidad colocación, menos complicaciones), con especial relevancia desde el punto de vista de la comodidad del paciente, superior en el Apósito 1 respecto al Apósito 4.(AU)

Objective: to assess the evolution of surgical wounds in patients undergoing total knee replacement surgery, using four different types of wound dressing.Method: an observational study on surgical patients with total knee replacement, from the Knee Orthopedic Surgery Unit of the Hospital Clínic (Barcelona). The first day after the procedure, the nurse treated the surgical wound (SW) and applied one dressing of the four used for the study. Each wound dressing was allocated to a 25-patient group. There was an assessment of time of permanence of the dressing, development of complications (phlyctena, dehiscence, exudate), comfort for the patient, and ease of application for the nurse. Evaluation measures were taken at seven days after the procedure, at the time of treatment in the outpatient unit. There was descriptive analysis, with frequencies, mean, and standard deviation (SD).Results: one hundred (100) patients were recruited. The mean time (SD) of permanence was higher for dressing 1: 6.34 (1.56). Surgical wound complications were lower with dressing 4 (1 phlyctena, no dehiscence). SW moderate/heavy exudate was lower with dressings 1 and 4 (16% in both cases). The nurse valued the ease of application for dressings 1, 2 and 4, in 100% of patients. The patients in the dressing 1 group reported higher comfort (96%), while the worse assessment was made by the subjects in the dressing 4 group (76%).Conclusions: wound dressings 1 and 4 have shown a higher number of favorable items (time of permanence, ease of application, lower number of complications), with special relevance from the point of view of patient comfort, superior with dressing 1 vs. dressing 4.(AU)

Coenzyme Q10 supplementation during in vitro maturation of bovine oocytes (Bos taurus) helps to preserve oocyte integrity after vitrification.

Oocyte vitrification causes less cell stress than slow cooling, but cytoskeletal and spindle alterations may occur affecting the oocyte competence. In vitro maturation (IVM) supplementation with different antioxidant molecules has been performed to attenuate this harmful stress. Coenzyme Q10 (CoQ10 ) supplementation has previously shown to have positive effects in bovine and mouse in vitro embryo development. The aim of this study was to evaluate the effects of CoQ10 during bovine oocyte IVM and vitrification. Cumulus-oocyte complexes (COCs) (n = 311) were cultured under standard maturation conditions with 0 µM (control), 25 µM and 50 µM CoQ10 supplementation. After 22 hr, a cohort of 170 oocytes both from the control and from CoQ10 -supplemented groups were vitrified, warmed and returned to incubation until 24 hr of maturation, while the rest of the oocytes (n = 141) remained fresh. Then, oocyte survival was assessed morphologically by stereomicroscopy. Oocytes from all groups were then fixed and stained for assessing cortical granules (CG) migration and nuclear stage. High rates of oocyte MII progression and appropriate CG migration as a continuous layer beneath the plasma membrane were obtained both in control and in CoQ10 groups. Results showed that although vitrification has great impact in survival of IVM bovine oocytes, 50 µM CoQ10 supplementation significantly improved oocyte survival (p = .045) and reduced the premature CG exocytosis, helping to preserve the CG migration pattern (31.3% control vs. 54.5% in 50 µM CoQ10 ; p = .039), attenuating the negative effects of vitrification.

Predicting high risk of exacerbations in bronchiectasis: the E-FACED score.

BACKGROUND: Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients. OBJECTIVE: Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality. METHODS: The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts. RESULTS: A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P<0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED. CONCLUSION: E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.

Prevalence and factors associated with nontuberculous mycobacteria in non-cystic fibrosis bronchiectasis: a multicenter observational study.

BACKGROUND: Data on the prevalence of and factors associated with nontuberculous mycobacteria (NTM) in patients with non-cystic fibrosis (CF) bronchiectasis are limited. Our aim was to determine the prevalence and factors associated with isolation of NTM in this population. METHODS: We performed a multicenter observational study of historical cohorts comprising consecutive patients with non-CF bronchiectasis and at least 2 sputum samples cultured for mycobacteria over a period of 5 years. RESULTS: The study population included 218 adult patients (61.9 % women) with a mean (SD) age of 55.7 (16) years and a mean (SD) of 5.1 (3.3) cultures/patient. NTM was isolated from sputum in 18 patients (8.3 %). Of these, 5 patients (28 %) met the American Thoracic Society criteria for NTM disease. Mycobacterium avium complex was the most frequently isolated microorganism (9 patients, 4.1 %). The variables independently associated with isolation of NTM were FVC ≥ 75 % predicted (OR, 4.84; 95 % CI 1.47 to 15.9; p < 0.05), age ≥ 50 years (OR, 4.74; 95 % CI 1.25 to 17.97; p < 0.05), and body mass index (BMI) ≤ 23 kg/m(2) (OR, 2.97; 95 % CI 1.03-8.58; p < 0.05). Patients with these three characteristics had a 40 % probability of having at least one isolation of NMT. CONCLUSIONS: A significant number of patients with non-CF bronchiectasis are positive for the isolation of NTM. M. avium complex is the most frequently isolated mycobacteria. FVC ≥ 75 % predicted, age ≥ 50 years, and a BMI ≤ 23 kg/m(2) were independently associated with the presence of NTM in patients with non-CF bronchiectasis.

Magnesium sulphate and 123I-MIBG in pheochromocytoma: two useful techniques for a complicated disease / Utilidad de la gammagrafia con 123 I-MIBG y del Sulfato de Magnesio en el diagnóstico y tratamiento del feocromocitoma

Pheochromocytoma is a tumour of the chromaffin tissue. It may, through catecholamine release, have deleterious effects on myocardial structure. A 48-year-old woman with a history of hypertension and type II diabetes mellitus (ASA II) was diagnosed of pheochromocytoma-induced myocarditis, which caused severe cardiogenic shock, with an ejection fraction of 20%. Extreme blood pressure swings required aggressive therapy with vasoactive drugs (norepinephrine and dopamine) and an intra-aortic balloon pump, despite which severe haemodynamic instability persisted. Finally, the use of magnesium sulphate allowed for cardiovascular stabilization and weaning off vasoactive drugs prior to surgery. 123I-metaiodobenzylguanidine scintigraphy helps not only to functionally confirm tumour tissue, but also to assess severity and prognosis of cardiac failure. Prognosis of pheochromocytoma-induced heart failure can be very poor. The use of these two well-known and relatively simple ‘tools’ for treatment and prognosis is a helpful option to keep in mind (AU)

Los feocromocitomas son tumores del tejido cromafín. Pueden, a través de la secreción de catecolaminas, causar efectos deletéreos sobre el miocardio. Una mujer de 48 años, con antecedentes de hipertensión arterial y diabetes mellitus tipo II (ASA II) fue diagnosticada de feocromocitoma, con miocardiopatía, y shock cardiogénico con fracción de eyección del 20%. Las extremas oscilaciones hemodinámicas requirieron tratamiento con fármacos vasoactivos (noradrenalina y dopamina) así como el uso de un balón de contrapulsación intra-aórtico, a pesar de lo cual persistía la inestabilidad. Finalmente, el uso de sulfato de magnesio permitió la estabilización de la paciente, pudiéndose retirar las drogas vasoactivas previo a la cirugía. El uso de la gammagrafía con 123-metayodobenzilguanidina sirve no sólo para la clasificación funcional del tejido tumoral, sino también para evaluar la severidad y pronóstico del fallo cardíaco. El pronóstico de la insuficiencia cardíaca inducida por feocromocitoma puede ser grave. El uso de estas conocidas y relativamente sencillas ‘herramientas’ para el tratamiento y el pronóstico son una opción útil a tener en cuenta (AU)

Magnesium sulphate and (123)I-MIBG in pheochromocytoma: Two useful techniques for a complicated disease.

Pheochromocytoma is a tumour of the chromaffin tissue. It may, through catecholamine release, have deleterious effects on myocardial structure. A 48-year-old woman with a history of hypertension and type II diabetes mellitus (ASA II) was diagnosed of pheochromocytoma-induced myocarditis, which caused severe cardiogenic shock, with an ejection fraction of 20%. Extreme blood pressure swings required aggressive therapy with vasoactive drugs (norepinephrine and dopamine) and an intra-aortic balloon pump, despite which severe haemodynamic instability persisted. Finally, the use of magnesium sulphate allowed for cardiovascular stabilization and weaning off vasoactive drugs prior to surgery. (123)I-metaiodobenzylguanidine scintigraphy helps not only to functionally confirm tumour tissue, but also to assess severity and prognosis of cardiac failure. Prognosis of pheochromocytoma-induced heart failure can be very poor. The use of these two well-known and relatively simple 'tools' for treatment and prognosis is a helpful option to keep in mind.

Coagulation profiles of unexpected DCDD donors do not indicate a role for exogenous fibrinolysis.

It has been suggested that vascular stasis during cardio-circulatory arrest leads to the formation of microvascular thrombi and the viability of organs arising from donation after circulatory determination of death (DCDD) donors may be improved through the application of fibrinolytic therapy. Our aim was to comprehensively study the coagulation profiles of Maastricht category II DCDD donors in order to determine the presence of coagulation abnormalities that could benefit from fibrinolytic therapy. Whole blood from potential DCDD donors suffering out-of-hospital cardiac arrest was sampled after declaration of death in the emergency department, and rotational thromboelastomeric analysis was performed. Between July 2012 and December 2013, samples from 33 potential DCDD donors were analyzed. All patients demonstrated hyperfibrinolysis (HF), as reflected by maximum clot lysis of 98-100% in all cases, indicating that there is no role for additional fibrinolytic therapy in this setting. As well, we observed correlations between thromboelastomeric lysis parameters and maximum hepatic transaminase levels measured in potential donors and renal artery flows measured during ex situ hypothermic oxygenated machine perfusion, indicating that further studies on the utility of thromboelastometry to evaluate organ injury and perhaps even viability in unexpected DCDD may be warranted.

Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction: A case report in the perioperative setting / Movimiento sistólico anterior de la válvula mitral con obstrucción del tracto de salida del ventrículo izquierdo: un caso clínico en el perioperatorio

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Trastorno de conversión tras cefalea pospunción dural y parche epidural con dextrano / Conversion disorder after post-dural puncture headache and epidural patch with dextran

No disponible

Accidente cerebrovascular con transformación hemorrágica en una paciente con tratamiento antiagregante intervenida de macroadenoma hipofisario / Cerebrovascular accident with haemorrhagic transformation in a patient on antiplatelet treatment subjected to surgery of a hypophyseal macroadenoma

Presentamos el caso de una mujer de 51 años, propuesta para resección endoscópica endonasal transesfenoidal de macroadenoma hipofisario diagnosticado en el contexto de un ictus isquémico transitorio sufrido 10 semanas antes de la fecha de la intervención. Durante este tiempo había seguido tratamiento con antiagregantes plaquetarios, que se retiraron 5 días antes de la cirugía. La intervención se realizó sin incidencias. En el segundo día del postoperatorio, la paciente presentó un infarto isquémico del hemisferio cerebeloso izquierdo con signos de hidrocefalia y posterior transformación hemorrágica, con muerte encefálica a los 5 días de la intervención. No existen guías definitivas respecto al uso de antiagregantes en el peroperatorio neuroquirúrgico. Por otro lado, tampoco existe acuerdo respecto al tiempo a esperar entre un evento cerebrovascular y la cirugía, aunque parece que entre 4 y 12 semanas sería lo más aconsejable. Se resalta la importancia de una evaluación individual de cada paciente ante una cirugía, y se revisa el manejo del paciente antiagregado con riesgo trombótico en el contexto de neurocirugía y sus posibles complicaciones postoperatorias(AU)

The importance of an individual assessment of each patient before surgery is emphasised, as well as a review of the antiplatelet management of the patient with a risk of thrombosis in the context of neurosurgery, and their possible postoperative complications. The case is presented of a 51 year-old woman, proposed for endoscopic endonasal transsphenoidal resection of a hypophyseal macroadenoma diagnosed in the context of a stroke suffered 10 weeks before the date of the surgery. During this time, she had been treated with antiplatelet drugs, which were withdrawn 5 days before the surgery. The surgical procedure was performed without any incidents. On the second day after the surgery, the patient had an ischaemic infarction of the left cerebellar hemisphere, with signs of hydrocephaly and a posterior haemorrhagic transformation, with brain death 5 days after the operation. There are no definitive guidelines on the use of antiplatelet drugs in the perioperative period of neurosurgery. Also, there is no agreement as regards the waiting time between a cerebrovascular event and surgery, it appears that between 4 and 12 weeks would be the most advisable. The importance of an individual assessment of each patient before surgery is emphasised, as well as a review of the antiplatelet management of the patient with a risk of thrombosis in the context of neurosurgery, and their possible postoperative complications(AU)

[Cerebrovascular accident with haemorrhagic transformation in a patient on antiplatelet treatment subjected to surgery of a hypophyseal macroadenoma]. / Accidente cerebrovascular con transformación hemorrágica en una paciente con tratamiento antiagregante intervenida de macroadenoma hipofisario.

The case is presented of a 51 year-old woman, proposed for endoscopic endonasal transsphenoidal resection of a hypophyseal macroadenoma diagnosed in the context of a stroke suffered 10 weeks before the date of the surgery. During this time, she had been treated with antiplatelet drugs, which were withdrawn 5 days before the surgery. The surgical procedure was performed without any incidents. On the second day after the surgery, the patient had an ischaemic infarction of the left cerebellar hemisphere, with signs of hydrocephaly and a posterior haemorrhagic transformation, with brain death 5 days after the operation. There are no definitive guidelines on the use of antiplatelet drugs in the perioperative period of neurosurgery. Also, there is no agreement as regards the waiting time between a cerebrovascular event and surgery, it appears that between 4 and 12 weeks would be the most advisable. The importance of an individual assessment of each patient before surgery is emphasised, as well as a review of the antiplatelet management of the patient with a risk of thrombosis in the context of neurosurgery, and their possible postoperative complications.

Utilidad del laringoscopio de suspensión de Kleinsasser para facilitar la intubación orotraqueal en tumores supraglóticos de laringe / No disponible

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