Evolución de los pacientes con insuficiencia cardiaca aguda secundaria a infarto agudo de miocardio tratados con ventilación mecánica no invasiva / Outcome of patients with acute heart failure secondary to acute myocardial infarction treated with noninvasive mechanical ventilation

Introducción y objetivos: La ventilación no invasiva (VNI) es capaz de reducir la necesidad de intubación endotraqueal y la mortalidad de los pacientes con insuficiencia cardiaca aguda (ICA). Sin embargo, de muchos de los ensayos clínicos se ha excluido a los pacientes con ICA secundaria a síndrome coronario agudo o infarto agudo de miocardio (SCA-IAM). El objetivo de este estudio es comparar la efectividad de la VNI entre pacientes con ICA desencadenada por SCA-IAM y por otras causas. Métodos: Estudio prospectivo de cohortes, durante un periodo de 20 años, de todos los pacientes con ICA tratados con VNI ingresados en una unidad de cuidados intensivos. Se agrupó a los pacientes por la presencia o ausencia de SCA-IAM como causante del evento de ICA. Se definió el fracaso de la VNI por la necesidad de intubación endotraqueal o muerte. Resultados: Se analizó a 1.009 pacientes, 403 (40%) con SCA-IAM y 606 (60%) con otras etiologías. La VNI fracasó en 61 casos (15,1%) del grupo de SCA-IAM y 64 (10,6%) del grupo sin SCA-IAM (p=0,031), sin diferencias en la mortalidad hospitalaria (el 16,6 y el 14,9%; p=0,478). Conclusiones: El SCA-IAM como causa desencadenante de la ICA no influye en el pronóstico de los pacientes con insuficiencia respiratoria aguda que precisan asistencia respiratoria no invasiva (AU)

Introduction and objectives: Noninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies. Methods: Prospective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death. Results: A total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P=.031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P=.478). Conclusions: The presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support (AU)

Validity and reliability of the HEMPA method for patient handling assessment.

Specific methods currently exist to assess occupational hazards resulting from patient handling in the healthcare sector, according to ISO/TR 12296. They are all similar in nature, but with a different analysis perspective; for that reason a comparison of the most relevant methods was performed in a previous research. As a result, a basis of a new tool that integrates the complementary aspects of those methods was proposed. To verify the validity and reliability of that method, a study within a hospital setting was carried out in five medical and surgical units of a public health institution. Based on the obtained results, the analysed method (called HEMPA) proved to be valid and reliable. Also, this method reflects a positive correlation between risk and damage and correctly quantifies risks regarding patient's dependence.

Communication gaps in knowledge of freshwater fish biodiversity: implications for the management and conservation of Mexican biosphere reserves.

To detect differences in the information available on freshwater fish species found in Mexican biosphere reserves, the number of species considered in three sources of information: management programmes, Global Biodiversity Information Facility (GBIF) and the scientific literature were compared. Additionally, management actions for the reserves were evaluated. More than 55% of freshwater fish species registered for the reserves were found only in one of the three sources of information, while just 12% was shared among all the three. Fifteen threatened species were registered in GBIF and the scientific literature that were not found in management programmes. Although all the management programmes described conservation actions, none of them gave details about how they would be implemented. Lack of communication among the sources studied, unawareness of the existence of threatened species and the absence of detailed management actions hinder the development of adequate conservation strategies.

Análisis de las técnicas continuas de sustitución renal en pacientes críticos con insuficiencia renal aguda / Continuous renal replacement therapies in critically-ill patients with acute renal failure

Fundamento. El fallo renal agudo (FRA) se asocia frecuentemente al síndrome de disfunción multiorgánica (SDMO) en los pacientes críticos. El uso de técnicas continuas de sustitución renal (TCSR) fue descrito por primera vez hace unos 20 años. Analizamos aquí nuestra experiencia valorando los factores pronósticos y la evolución clínica de los pacientes. Pacientes y métodos. Se realizó un estudio descriptivo, observacional y retrospectivo de todos los pacientes críticos con FRA tratados con TCSR, durante el período comprendido entre enero de 1996 y diciembre de 2000. Se recogieron datos demográficos y clínicos, y se realizó un análisis estadístico descriptivo, comparativo y de regresión logística para el estudio de los factores de riesgo relacionados con la mortalidad. Resultados. Fueron evaluados 73 pacientes. La media de edad fue 61 años (intervalo, 17-79), el 62 per cent eran varones, el APACHE II medio fue de 24 (8) y el SAPS II medio fue de 65 (16). La mortalidad global alcanzó el 86,3 per cent. Mediante regresión logística el riesgo de muerte fue más alto en los pacientes con complicaciones relacionadas con la técnica (OR = 2,00; IC del 95 per cent, 1,763-250,0; p = 0,016) y más bajo en pacientes con diuresis residual mayor (OR = 0,995; IC del 95 per cent, 0,990-0,999; p = 0,028). Conclusiones. La mortalidad del FRA que acompaña al SDMO sigue siendo elevada. Las TCSR pueden ser útiles en estos pacientes. En nuestra unidad la ausencia de complicaciones relacionadas con la técnica y la mayor diuresis residual se relacionan con una menor mortalidad. (AU)

Cuantificación de la actividad muscular en los grandes músculos de la extremidad inferior durante el mantenimiento de la postura erecta / No disponible

Es importante el conocimiento de la participación muscular en el mantenimiento de la postura. Se acepta que el esfuerzo muscular necesario para mantener la postura erecta es muy pequeño, pero no se suele indicar su valor. En este trabajo se ha pretendido cuantificar la participación de los músculos de la extremidad inferior durante esta actividad, para tener unos valores de referencia que nos ayuden en la evaluación del equilibrio postural y en el tratamiento de sus alteraciones. Mediante un sistema telemétrico y electrodos de superficie, se registró en 10 sujetos sanos la actividad eléctrica de los grandes músculos de extremidad inferior manteniendo una postura erecta y, además, para que sirviera como referencia, durante una contracción isométrica máxima y caminando. La actividad registrada durante el mantenimiento de la postura erecta y durante la marcha se expresó respecto a la obtenida durante la contracción máxima isométrica de cada uno de los músculos estudiados, por ser una referencia habitual en los estudios dinámicos, y, en el caso del mantenimiento de la postura se expresó, además, con respecto a la actividad media que se produce durante la marcha, ya que es una referencia fácil de tomar para el clínico. Al caminar, la participación muscular no es muy importante (25% de su actividad máxima isométrica-AMI), pero está lejos de la hallada en el mantenimiento de la postura, que no sobrepasa en ningún músculo de los estudiados el 4% de su AMI, y que supone valores inferiores al 33% de la obtenida durante la marcha (AU)

The knowledge about muscular participation in standing maintainance is very important. It is accepted that we need a little muscular effort to maintain the standing balance, but its value is not ussually indicated. In this work we have tried to cuantify the performance of the lower extremity muscles during this activity in order to have some reference values which help us in the evaluation of the standing balance and in the treatment of its problems. We recorded, in ten healthy subjects, using a telemetric system and surface electrodes, the electrical activity of the big muscles of the lower extremity during standing, and, besides, so as to have a reference, during a maximum isometric contraction and during walking. The recorded activity during standing and walking was expressed regarding the one obtained during a maximum isometric contraction of each of the studied muscles, since it is a normal reference in dynamic studies, and in the case of standing, this was expressed as well regarding the average activity which is produced during walking, as it is an easy refence for the clinic to take. On walking, the muscular performance is not of any great importance (25% of its maximum isometric activity -MIA-), but it is far from the one found during standing, which does not exceed the 4% of its MIA in any of the studied muscles, and which represents values under 33% of the one obtained walking (AU)

Estudio diana. Depresión con insomnio y ansiedad: nueva aproximación / DIANA study. Depression with Insomnia and Anxiety: New Approach

El estudio DIANA (Depresión con Insomnio y Ansiedad: Nueva Aproximación) es un estudio multicéntrico, observacional, abierto, no controlado, de fase IV y diseñado con el objetivo principal de evaluar la eficacia de mirtazapina en el control de la ansiedad asociada a la depresión. De forma secundaria, se recogió la eficacia de mirtazapina en los trastornos del sueño también asociados a la depresión, así como la tolerabilidad del fármaco.La población sujeta a estudio estuvo constituida por pacientes ambulatorios diagnosticados de depresión con un grado importante de ansiedad asociada. Se recogió a un total de 891 pacientes, de los que se incluyeron los análisis presentados a 885, realizándose evaluaciones en los días 0, 14 y 28 mediante la escala de Hamilton de depresión de 17 ítems (HAMD17), la escala de Hamilton de ansiedad (HAS) y la escala de Impresión Clínica Global (ICG).El análisis de eficacia puso de manifiesto una reducción significativa (p < 0,001) de la escala de Hamilton para la depresión desde el primer control (media inicial, 21,69; media final, 8,58), así como una reducción significativa de la HAS (p < 0,001) desde su primer control (media inicial, 23,38; media final, 8,82), también es evidente al analizar los cambios en la escala ICG y los porcentajes de las reducciones superiores al 50 por ciento de la puntuación basal de la HAS.La seguridad y la tolerancia observadas fueron muy favorables, mejor que las encontradas en otros estudios.En nuestra muestra, representativa por su tamaño y características de la población general de pacientes depresivos y con ansiedad de nuestro país, la mirtazapina ha evidenciado su eficacia en el tratamiento de la ansiedad asociada a la depresión, e incluso en el subanálisis que se ha realizado comparando dos grupos de tratamiento distintos, mirtazapina ha demostrado una eficacia totalmente equiparable a las benzodiazepinas en el tratamiento de la ansiedad (AU)

El ejercicio físico en el paciente trasplantado de riñón / Exercise training in renal transplanted patients

Se ha estudiado la modificación de la capacidad de esfuerzo en 24 pacientes trasplantados renales, tras un programa de ejercicio, realizándoles una prueba de esfuerzo antes y después de dicho programa. Tras el período de entrenamiento, se observa un descenso de la frecuencia cardiaca y de la tensión arterial sistólica en reposo (p<0,01). Existe un incremento significativo del consumo máximo de oxígeno del l7,89%, sin llegar a las cifras obtenidas en sujetos sedentarios de sus mismas caracteristicas morfométricas. El tiempo y la potencia alcanzada al final de la prueba es también superior, con un incremento medio del 31,09% y del 32,08% respectivamente. No hay cambios sustanciales de la frecuencia cardiaca ni de las cifras tensionales sistólicas al esfuerzo máximo, pero, al considerar que la intensidad del esfuerzo post-entrenamiento es mayor se deduce que con menor frecuencia cardíaca pueden lograr el nivel de esfuerzo realizado en la prueba inicial (AU)

We have studied the modifications in the effort capacity in 24 patients with a renal transplant after performing & programme of physical exercise. In order to do so they carried out an effort test before and after mentioned programme. After the training period, we observed a decrease of the cardiac frequency and the systolic arterial pressure during the rest (p<0,01). There is a significant increase of the maximum oxigen consume of 17,89%, without reaching the obtained data by sedentary subjects with the same morphometric features. The time and the power reached at the end of the test is superior as well, with an average increase of 31,09% and 32.08% respectively. There are not significant changes in the cardiac frequency nor in the systolic pressure data at maximum effort, but if we consider that the effort intensity after training is higher, we deduce that with lower cardiac frequency they can achieve the same level of the performed effort in te initial test (AU)

Prueba de esfuerzo en el paciente en tratamiento de hemodiálisis / Effort test in patients under treatment with hemodialysis

Un total de 57 pacientes, sometidos a hemodiálisis, han accedido a realizar una cicloergoespirometria. Se han valorado los parámetros aportados en situación de reposo, al máximo esfuerzo y recuperación. Los valores medios de la frecuencia cardíaca y de la tensión arterial de reposo se encuentran dentro de los límites de la normalidad. Los incrementos de VO2 y VCO2 durante el esfuerzo dependen de la intensidad del trabajo realizado (potencia, tiempo de pedaleo - P<0,001— y frecuencia cardiaca —P<0,05-). Al comparar los valores obtenidos al máximo esfuerzo con los valores teóricos, -extraídos de individuos sedentarios de sus mismas características morfométricas- se observa en estos pacientes un menor VO2 máximo, presentando un porcentaje de un 53% (S.D.=16,51) del teórico y se establece una reducción casi paralela de la potencia alcanzada 50,57% (SD.=16,78). Los parámetros respiratorios presentan unos valores ligeramente mayores (VE: 60,87%; S.D.=22,22) y la frecuencia cardíaca asciende a una media del 77,61 % (S.D.=14,51) de los valores previstos (AU)

57 patients, who underwent a hemodialysis, agreed to carry out an ycleergometry. The found parametres in rest situation in the maximum effort and in the recovery period were valued. The average values of the cardiac frequency and of the rest arterial pressure are found within normal limits. The increasements of VO2 and VCO2 during the effort depend on the intensity of the carried out work (power, pedalling time —p<0,001— and cardiac frequency -p<0,05-). On comparing the obtained values during the maximun effort with the theorical values, taken from passives individuals with their same morphometrical features, we observe in these patients a lower maximun of VO2, showing a 53% (S.D.= 16,51) from the theorical one, and an almost paralel reduction of the reached power (50,57%; S.D.=16,78) is established. The breathing parameters show slightly higher values (VE:BO,B7%; S.D.=22,22) and the cardiac frequency increases to an average of 77,61% (S.D.= 14,51) of the estimated values (AU)

Fluvastatin and low-density lipoprotein oxidation in hypercholesterolemic renal transplant patients.

BACKGROUND: Hyperlipidemia contributes to the development and progression of vascular disease in organ transplant patients. Oxidative modification of low-density lipoproteins (LDLs) has been suggested as a key event in early atherogenesis. METHODS: We conducted a pilot study in renal transplanted patients with persistent hypercholesterolemia above 6.5 mmol/liter. We studied the LDL oxidation before and after one year of fluvastatin treatment. Twenty patients (12 males and 8 females, 46 +/- 10 years old) who received a kidney transplant 24 +/- 18 months before the study were treated with fluvastatin (20 mg/day for 12 weeks). Patients with a total cholesterol under 6.3 mmol/liter continued to receive 20 mg/day for another 40 weeks (group I, N = 10). Nine patients with a total cholesterol above 6.3 mmol/liter received 40 mg/day for a further 40 weeks (group II). RESULTS: Cyclosporine levels did not experience a significant variation. Total and LDL cholesterol decreased significantly in both groups (21.7 and 27.9% in group I, 18.3 and 27.2% in group II, respectively). The lag-phase time, which was significantly enlarged before fluvastatin treatment in the patients with respect to the controls (N = 18, 82 +/- 45 vs. 50 +/- 8 min) was shortened after one year of fluvastatin treatment (64 +/- 24 vs. 50 +/- 8 min, P = 0.04). Fluvastatin was stopped in only one patient because of nausea and vomiting. Transaminases and creatin-phospho-kinase were not altered. All of the patients maintained a functioning graft during the study period. CONCLUSIONS: Fluvastatin significantly reduced total and LDL cholesterol, without interferences with cyclosporine A through levels. Fluvastatin has not demonstrated an antioxidant effect in our renal hypercholesterolemic transplant patients.

Discriminant analysis algorithm based on a distance function and on a Bayesian decision.

We propose a new algorithm for the allocation of an individual to one of several possible groups or populations. The algorithm enables us to define a finite partition over the sample space, based on distance function. This partition is used, jointly with the application of a standard Bayesian decision rule, to allocate individuals to the populations. The algorithm also provides a measure of the allocation confidence for each individual, in a similar manner to that of logistic regression. The error rates for classification are also computed using the leave-one-out method. Results are compared with those obtained with other discriminant analysis techniques previously reported: Fisher's linear discriminant function, the quadratic discriminant function, logistic discrimination, and others.

[Effects of exercise in the elderly with chronic renal failure]. / Efectos del entrenamiento en el insuficiente renal crónico anciano.

The population studied in this paper is composed of 10 patients under hemodialysis, who have underwent a general exploration, a stress test, a spirometry, an analytic control and assessment of exercise their psychological situation, before and after the programme. At the end of the training programme there is an important increase in the SVC and the FVC, as well as the power and time of the stress test. The psychological state improves as well as the anaemia.

ADH and phylogenetic relationships of Drosophila lebanonesis (Scaptodrosophila).

Increasing data on Drosophila alcohol dehydrogenase (ADH) sequences have made it possible to calculate the rate of amino acid replacement per year, which is 1.7 x 10(-9). This value makes this protein suitable for reconstructing phylogenetic relationships within the genus for those species for which no molecular data are available such as Scaptodrosophila. The amino acid sequence of Drosophila lebanonensis is compared to all of the already known Drosophila ADHs, stressing the unique characteristic features of this protein such as the conservation of an initiating methionine at the N-terminus, the unique replacement of a glycine by an alanine at a very conserved position in the NAD domain of all dehydrogenases, the lack of a slow-migrating peptide, and the total conservation of the maximally hydrophilic peptide. The functional significance of these features is discussed. Although the percent amino acid identity of the ADH molecule in Drosophila decreases as the number of sequences compared increases, the conservation of residue type in terms of size and hydrophobocity for the ADH molecule is shown to be very high throughout the genus Drosophila. The distance matrix and parsimony methods used to establish the phylogenetic relationships of D. lebanonensis show that the three subgenera, Scaptodrosophila, Drosophila, and Sophophora separated at approximately the same time.

[Randomized double-blind study of delayed-action verapamil as a single dose versus 2 doses daily in patients with moderate hypertension]. / Etude randomisée en double aveugle du vérapamil LP en 1 prise versus 2 prises quotidiennes chez l'hypertendu modéré.

The antihypertensive action of sustained release verapamil is, in the majority of cases, obtained with a dosage of 240 mg per day. In certain patients, it is necessary to increase the daily dose to 360 or even 480 mg. This dosage increase most often leads to twice daily administration. In the present trial (18 patients included), the efficacy 360 mg of sustained release verapamil was compared double-blind with that of 360 mg as two divided doses. The antihypertensive action of sustained release verapamil as a single dose was shown to be identical to that of two daily doses. It is therefore felt to be unnecessary to increase the number of daily doses in parallel with dosage increases. There is absolutely no doubt that single dose monotherapy leads to better compliance.

The primary structure of alcohol dehydrogenase from Drosophila lebanonensis. Extensive variation within insect 'short-chain' alcohol dehydrogenase lacking zinc.

Insect alcohol dehydrogenase is highly different from the well-known yeast and mammalian alcohol dehydrogenases. The enzyme from Drosophila lebanonensis has now been characterized by protein analysis and was found to have a 254-residue protein chain with an acetyl-blocked N-terminal Met. Comparisons with the structures of the enzyme from other species allows judgement of the extent of variability within the insect alcohol dehydrogenases. They have diverged to a considerable extent; two forms analyzed at the protein level differ at 18% of all residues, and all the known Drosophila alcohol dehydrogenase structures reveal differences at 72 positions. Some deviations, against a background similarity, in the extent of changes are noted among the parts corresponding to different exons. The structural variation within Drosophila is about as large as the one for the mammalian zinc-containing alcohol dehydrogenase. Consequently, the results illustrate Drosophila relationships and establish great variations also for group of alcohol dehydrogenases lacking zinc.