Differential clinical characteristics and outcome predictors of acute heart failure in elderly patients.

OBJECTIVE: We determined the clinical-epidemiological characteristics and prognostic factors of early mortality and re-consultation in an elderly population attending the hospital emergency department (HED) for acute heart failure (AHF). PATIENTS AND METHODS: A prospective, observational, non interventional study including all the patients with AHF attended in the Spanish's HED. Two groups were defined: elderly (≥ 80 years) and controls (< 80 years). VARIABLES: demographic characteristics, comorbidity, degree of cardiac involvement, previous treatment, symptoms and signs of the AHF episode, precipitating factors, treatment in the HED and outcome. OUTCOME VARIABLES: mortality and re-consultation within 30 days. RESULTS: Of the 942 patients included, 455 of whom were elderly (48.3%). In this elderly population female sex, auricular fibrillation and a history of ictus and a poor functional status predominated. The type of ventricular dysfunction was unknown in 70%. No main differences in the presentation of AHF were found between the two groups. Mortality and re-consultation to the HED within 30 days were similar in both groups. While several factors were identified to be related to mortality or re-consultation in control group, in the elderly group it was more difficult to identify patients who will die or re-consult to the HED within the following 30 days. Only respiratory insufficiency on arrival to the HED was found to predict a greater probability of death (OR 3.55; CI95% 1.39-9.11). CONCLUSIONS: AHF in elderly patients presents some differential characteristics and, most importantly, it is more difficult to identify which of these patients will die or re-consult in the short-term.

Inhibition of poly (ADP-ribose) polymerase-1 enhances doxorubicin activity against liver cancer cells.

The purpose of this study was to investigate whether PARP-1 inhibition sensitizes human liver cancer cell lines to doxorubicin treatment. Both the addition of PARP-1 inhibitor (ANI) and depletion by means of stable siRNA significantly enhanced the growth inhibition induced by the DNA damage agents used. This effect was associated with an accumulation of unrepaired DNA, with a reduction in EGFR and Bcl-xL gene expression as well as with positive annexin-V staining. These results provide novel evidence of the direct role of PARP-1 in tumour chemoresistance in relation to its effects on the transcription of key genes involved in tumour survival.

Valoración fisioterápica del paciente con dolor / Physiotherapy assessment of the patient with pain

La anamnesis es uno de los puntos imprescindibles para el correcto tratamiento del paciente con dolor. Por tanto, se considera fundamental una adecuada valoración por parte del fisioterapeuta. En el artículo se describen unas pautas de actuación base sobre las cuales cada profesional realizará el seguimiento de sus pacientes de manera detallada. La localización de su dolor, su intensidad, así como su calidad y cronología son algunos de los puntos tratados (AU)

Thermal inactivation of Bacillus cereus spores affected by the solutes used to control water activity of the heating medium.

The heat resistance of B. cereus spores (ATCC 7004, 4342 and 9818) over a wide temperature range (92-125 degrees C) in aqueous solutions of NaCl, LiCl, sucrose and glycerol at different water activities (1.00-0.71) was investigated. Sodium chloride in the heating medium tended to protect the spores of B. cereus against heat. The z-values increased significantly (P < 0.05) at and above a concentration of 4.0 M. The effects of LiCl were lower than those caused by the NaCl at the same a(w) values. An increase in z-values was observed. but the differences were only statistically significant (P<0.05) at the highest concentration tested (5.0 M). A concentration of sucrose 0.87 M caused in all cases a reduction in D-values, which was most pronounced for strains 4342 and 9818. With increasing concentration of sucrose ( > 0.87 M), the D-values showed an increase, although only those obtained for strain 4342 in sucrose solutions 2.22 M were higher than those found in pure water. The z-values were significantly higher (P < 0.05) when sucrose was added at concentrations above 1.42 M, except for strain 4342. When a(w) was lowered from 0.96 to 0.71 with glycerol, D-values obtained gradually increased, about 30, 50 and 60 fold for 4342, 7004 and 9818 strains, respectively. No significant effect on z-values were detected.