Pb2+ complexes of small-cavity azamacrocyclic ligands: thermodynamic and kinetic studies.

The synthesis, acid-base behavior and Pb2+ coordination chemistry of the new aza-scorpiand like ligand 5-[2-(N-2-fluorenyl)ethylamino]-2,5,8-triaza[9]-2,6-pyridinophane (L1) have been studied by potentiometry, NMR and spectrofluorimetric titrations, and the results are compared with those obtained for the related compounds L2, lacking the fluorenyl group, and L3, the macrocycle lacking the pendant arm. The crystal structures obtained for complexes [PbL1][PbL1Cl](NO3)Cl2·4H2O (1) and [PbL3](ClO4)2 (2) reveal that the metal ion is located over the plane defined by the nitrogen atoms of the macrocyclic core due to its inability to accommodate the large Pb2+ ion in the macrocyclic cavity. For L1, the secondary amino group of the pendant arm is implicated in the coordination of the metal ion, although the stereoactive lone pair of Pb2+ prevents the closed conformation associated with the coordination of metal ions in aza-scorpiand derivatives. The kinetics of the acid-promoted dissociation of the ligand from the Pb2+ complexes with the three ligands have been studied using stopped-flow with simultaneous absorbance and fluorescence detection. The results indicate that in spite of their similarity, the dissociation of the metal ion occurs with very different rates in the three complexes. During the course of the kinetic studies evidence was obtained for the occurrence of a photochemical process that leads to ligand degradation with the unexpected elimination of one CH2CH2 fragment from the macrocyclic core.

Percepciones de pacientes y profesionales sanitarios sobre la calidad de la atención a personas diabéticas / Patient and health professional perceptions on the quality of care provided to diabetic patients

Objetivo. Describir la percepción y el conocimiento de pacientes y profesionales sanitarios (PS) sobre los factores que influyen en la calidad y continuidad asistencial de los cuidados prestados en atención primaria a personas diabéticas. Material y métodos. Estudio cualitativo de trayectoria fenomenológica. Participantes: profesionales médicos y de enfermería que trabajan en diferentes centros de atención primaria de Zaragoza y pacientes con diabetes atendidos en esos centros. Entre febrero y marzo de 2010 se realizaron 2 entrevistas grupales (grupos de discusión) y 6 individuales. Se siguió un guión preestablecido con las variables a explorar. Resultados. Los pacientes y profesionales entrevistados identificaron dificultades para asumir la diabetes como una enfermedad crónica. Se observaron como factores relacionados con problemas en el cambio de hábitos y estilos de vida el sexo (las mujeres mostraron mayores dificultades para el cambio), el tipo de trabajo y la situación de actividad laboral. Por parte de los profesionales entrevistados, se identificaron como factores favorecedores la existencia de guías y protocolos y la motivación personal, y como factores que dificultan la asistencia, la falta de tiempo y los sistemas de información existentes. Hay discrepancias entre los profesionales respecto al papel de grupos de pacientes y asociaciones. Conclusiones. En el diseño de intervenciones para la modificación de estilos de vida de los pacientes diabéticos se deben tener en cuenta las dificultades para el cambio ligadas al sexo y la situación laboral de los pacientes(AU)

Objective. To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. Material and methods. A qualitative study using a phenomenological perspective. Participants. Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. Results. The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. Conclusions. It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients(AU)

[Patient and health professional perceptions on the quality of care provided to diabetic patients]. / Percepciones de pacientes y profesionales sanitarios sobre la calidad de la atención a personas diabéticas.

OBJECTIVE: To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. MATERIAL AND METHODS: A qualitative study using a phenomenological perspective. PARTICIPANTS: Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. RESULTS: The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. CONCLUSIONS: It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients.

Periodontal regeneration following implantation of cementum and periodontal ligament-derived cells.

BACKGROUND AND OBJECTIVE: The periodontal regeneration of bone defects is often unsatisfactory and could be largely improved by cell therapy. Therefore, the purpose of this study was to evaluate the regenerative potential of implanting canine cementum-derived cells (CDCs) and canine periodontal ligament-derived cells (PDLDCs) in experimentally created periodontal intrabony defects in beagle dogs. MATERIAL AND METHODS: Cells were obtained from premolars extracted from four beagle dogs. Three-wall intrabony periodontal defects, 3 mm wide and 4 mm deep, were surgically created in their second and fourth premolars and plaque was allowed to accumulate. Once the defects were surgically debrided, periodontal regeneration was attempted by random implantation of collagen sponges embedded with 750,000 CDCs, 750,000 PDLDCs or culture medium. After 3 mo of healing, specimens were obtained and periodontal regenerative outcomes were assessed histologically and histometrically. RESULTS: The histological analysis showed that a minimal amount of new cementum was formed in the control group (1.56 ± 0.39 mm), whereas in both test groups, significantly higher amounts of new cementum were formed (3.98 ± 0.59 mm in the CDC group and 4.07 ± 0.97 mm in the PDLDC group). The test groups also demonstrated a larger dimension of new connective tissue, resulting in a significantly more coronal level of histological attachment. CONCLUSION: This proof-of-principle study suggests that cellular therapy, in combination with a collagen sponge, promoted periodontal regeneration in experimental intrabony periodontal defects.

Oncology outside hospital: a new experience for the benefit of longer survivors

In May 2007, the Consorcio Hospital General Universitario de Valencia created the position of "Liaison Oncologist". The holder of this position is responsible for coordinating specialised and primary hospital care in the geographic area of Valencia known as Health Care Department 9 to reduce the waiting time between cancer diagnosis and treatment. In this article we describe the implementation of the innovative proposal of the Liaison Oncologist's Consultation Clinic, which, apart from speeding up and directing diagnostic processes, facilitates access to treatment, prevents duplication of consultations and exploratory procedures by establishing therapeutic plans (preferential channels), gives continuity to diagnostic and therapeutic mechanisms, and permits active follow-up of patients who have finished treatment. An analysis of the results obtained shows that the clinic has allowed us to integrate the various aspects of medical oncology into one system and make it available to patients and primary and specialised care professionals. This system provides the patient with the highest quality of integrated health care, ensures the availability of continued health care to long-term survivors and establishes preferential channels between primary care and specialised cancer care to achieve a quick diagnosis (AU)

IMS: a new technology to develop a telemedicine system.

The emergent IMS (Internet Protocol Multimedia Subsystem) technology appears to improve the current communication technologies. Its characteristics, such as Quality of Service (QoS), make it an advantageous system for innovative applications. Providing integrated services to users is one of the main reasons for the existence of IMS. Operators provide the technology as an open source, to be able to use services developed by researchers. Combining and integrating them, users will receive completely new services. Our proposal of use for IMS is the development of a telemedicine platform, designed to support not only remote biological signal monitoring, but value-added services for diagnosis and medical care, both of these working in real time.

A method for the determination and hardware validation of biosignal processing parameters.

This paper proposes an iterative procedure for the determination of parameters and working conditions of biomedical signal processing algorithms. A systematization of the process required to determine the parameters is proposed, avoiding "trial and error" tests, and considering all the specific requirements of a Telemedicine system, such as reliability and guaranteed signal reconstruction quality. An application of the method is included, also, focusing on ECG processing. Hardware platform Biolet(E) is designed for validation in an electronic implementation.

Massive intraperitoneal stromal tumour: two-year follow-up.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are rare. Few cases of such tumours are reported in the literature. Until recently, they were only treated surgically but, nowadays, for high grade tumours, we can consider wide excision, not only as a palliative measure, but also to enable subsequent treatment with Imatinib mesylate. METHODS: We describe the case of a patient with a high-grade GIST, who, two years after undergoing surgery and medical treatment, is still in remission. Computerised axial tomography (CT) of the abdomen detected the presence of multiple heterogeneous solid masses of various sizes but no localised retroperitoneal adenopathies. MAIN FINDINGS: Median laparotomy was performed and revealed multiple intraperitoneal tumours. The larger masses were excised and the smaller residual implants are currently being treated with Imatinib mesylate. The patient had visceral, parietal and peritoneal dissemination. One of them, located in the supramesocolic area, had a maximal diameter of 20cm. Another one, at the level of the retro-gastric space, had a diameter of 22cm. The other tumours were smaller and spread over the parietal and visceral peritoneum, mainly between the loops of the small intestine and pelvis. Two years after cytoreduction surgery, the patient is well and free of obvious disease and has shown a good tolerance to pharmacological treatment. CONCLUSIONS: Imatinib mesylate has revolutionised the treatment of GIST and offers good palliation and prolongation of overall survival.

Diagnóstico y tratamiento de una malformación vascular yeyunal, mediante laparoscopia / Diagnosis and treatment of a vascular malformation in the jejunum by laparoscopy

No disponible

Isquemia cerebral secundaria a una endocarditis trombótica no bacteriana como forma de presentación de un tumor ovárico / Cerebral ischaemia secondary to non-bacterial thrombotic endocarditis as the presenting symptom of an ovarian tumour

Introducción. En los pacientes con cáncer, los accidentes cerebrovasculares (ACV) son la complicación en sistema nervioso central más común después de las metástasis. Una de sus etiologías es la endocarditis trombótica no bacteriana (ETNB), que se presenta de forma excepcional como primera manifestación del tumor. Las manifestaciones clínicas de la ETNB son resultado del embolismo sistémico múltiple. Los émbolos se componen de plaquetas y hebras de fibrina que se depositan en las válvulas cardíacas, en el contexto de un estado de hipercoagulabilidad secundario al tumor. Los tumores más frecuentemente asociados a ETNB son los adenocarcinomas secretores de mucina. En las diferentes series publicadas, los casos de cáncer de ovario con ETNB son excepcionales. Caso clínico. Mujer de 58 años que, previamente asintomática, presentó de forma brusca disminución de nivel de conciencia, hemiplejía derecha y afasia motora. La tomografía axial computarizada a las 48 horas mostraba dos lesiones isquémicas agudas en el hemisferio izquierdo. La resonancia magnética cerebral con secuencia de difusión mostró múltiples lesiones isquémicas en diferentes territorios arteriales. El ecocardiograma transtorácico a las 24 horas mostraba una vegetación en el velo posterior de la válvula mitral. La paciente se trató con heparina sódica intravenosa y no volvió a presentar nuevos ACV. Las lesiones valvulares desaparecieron tras el tratamiento. En un estudio de búsqueda neoplasia oculta, se halló un tumor ovárico derecho. Conclusiones. La posibilidad de ETNB debe considerarse en casos de embolia cerebral de origen desconocido. La mayoría de pacientes muestran datos analíticos de coagulación intravascular diseminada crónica. Para el diagnóstico las pruebas más útiles son el ecocardiograma transesofágico y la resonancia magnética cerebral con secuencia de difusión. El tratamiento de elección es la heparina (AU)

Introduction. In cancer patients, cerebrovascular accidents (CVA) are the most common complication occurring in the central nervous system after metastasis. One of its causations is non-bacterial thrombotic endocarditis (NBTE), which appears on rare occasions as the first symptom of the tumour. The clinical manifestations of NBTE are the result of multiple systemic embolism. Emboli consist of platelets and strands of fibrin that are deposited in the valves of the heart, within a context of a state of hypercoagulability secondary to the tumour. The tumours that are most frequently associated to NBTE are mucin-secreting adenocarcinomas. Cases of ovarian cancer with NBTE are rare in the different series reported in the literature. Case report. We describe the case of a 58-year-old female, previously asymptomatic, who suddenly showed a lowered level of consciousness, hemiplegia on the right-hand side and motor aphasia. A computerised axial tomography scan taken at 48 hours showed two acute ischaemic lesions in the left hemisphere. Magnetic resonance imaging of the brain with diffusion sequences revealed multiple ischaemic lesions in different arterial territories. Transthoracic echocardiography at 24 hours showed a vegetation on the posterior leaflet of the mitral valve. The patient was treated with intravenous sodium heparin and no new CVA appeared. The valve injuries disappeared after treatment. In a study conducted to search for occult neoplasia, a tumour was found in the right ovary. Conclusions. NBTE must be taken into account in cases of cerebral embolism due to unknown causes. The results of the analyses of most patients reveal chronic disseminated intravascular coagulation. The most valuable diagnostic tests are the transesophageal echocardiogram and magnetic resonance imaging of the brain with diffusion sequences. Preferred treatment is with heparin (AU)

[Cerebral ischaemia secondary to non-bacterial thrombotic endocarditis as the presenting symptom of an ovarian tumour]. / Isquemia cerebral secundaria a una endocarditis trombótica no bacteriana como forma de presentación de un tumor ovárico.

INTRODUCTION: In cancer patients, cerebrovascular accidents (CVA) are the most common complication occurring in the central nervous system after metastasis. One of its causations is non-bacterial thrombotic endocarditis (NBTE), which appears on rare occasions as the first symptom of the tumour. The clinical manifestations of NBTE are the result of multiple systemic embolism. Emboli consist of platelets and strands of fibrin that are deposited in the valves of the heart, within a context of a state of hypercoagulability secondary to the tumour. The tumours that are most frequently associated to NBTE are mucin-secreting adenocarcinomas. Cases of ovarian cancer with NBTE are rare in the different series reported in the literature. CASE REPORT: We describe the case of a 58-year-old female, previously asymptomatic, who suddenly showed a lowered level of consciousness, hemiplegia on the right-hand side and motor aphasia. A computerised axial tomography scan taken at 48 hours showed two acute ischaemic lesions in the left hemisphere. Magnetic resonance imaging of the brain with diffusion sequences revealed multiple ischaemic lesions in different arterial territories. Transthoracic echocardiography at 24 hours showed a vegetation on the posterior leaflet of the mitral valve. The patient was treated with intravenous sodium heparin and no new CVA appeared. The valve injuries disappeared after treatment. In a study conducted to search for occult neoplasia, a tumour was found in the right ovary. CONCLUSIONS: NBTE must be taken into account in cases of cerebral embolism due to unknown causes. The results of the analyses of most patients reveal chronic disseminated intravascular coagulation. The most valuable diagnostic tests are the transesophageal echocardiogram and magnetic resonance imaging of the brain with diffusion sequences. Preferred treatment is with heparin.

Morbid obesity: postsurgical predictive factors and prioritization of the waiting list.

AIM: To study a sample of patients with morbid obesity who are on the waiting list for a surgical intervention, to establish various scores of surgical risk (Possum and severity score), and to assess potential criteria for list prioritization. DESIGN: We calculated physiological and surgical Possum scores for every patient, and analysed comorbidities and other associated factors to calculate the severity score. Likewise, we calculated the predictive rates of morbimortality. Differences between associated comorbidities in body mass index (BMI) were also analyzed. The correlation between Possum score, prediction rates, and severity score were analyzed. PATIENTS: Fifty-two patients on the surgical waiting list in our institution (San Juan University Hospital, Reus) from 26/4/02 to 5/03/04. RESULTS: The mean qualitative score is significantly higher in the female sex. Invalidating arthropathy and socio-occupational and/or psychiatric criteria are significantly higher in women. There is a significant correlation between the severity score and Possum score. Age does not correlate with any of the variables studied. CONCLUSIONS: Possum scores are significantly related to BMI, particularly in terms of morbidity rates. The degree of correlation between the Possum score and the qualitative score tells how useful the latter is to cover other determinant factors in the severity of this condition. Socio-occupational and psychiatric criteria, and invalidating arthropathy are the main variables to be taken into account for postsurgical prediction, and are directly related to BMI degree.

Obesidad mórbida: factores predictivos postquirúrgicos y priorización de la lista de espera / Morbid obesity: postsurgical predictive factors and priorization of the waiting list

Objetivo: estudio de una muestra de pacientes afectos deobesidad mórbida y en lista de espera para intervención quirúrgica,determinar el riesgo quirúrgico según diferentes scores (Possumy score de gravedad) y valorar los posibles criterios en la priorizaciónde dicha lista. Diseño: cálculo del Possum fisiológico y quirúrgico para cadapaciente y análisis de las comorbilidades y otros factores asociadospara el cálculo del score de gravedad. Cálculo de los ratiospredictivos de morbi-mortalidad. Análisis de las diferencias observadas,según el índice de masa corporal (IMC), de las comorbilidadesasociadas. Análisis del grado de correlación entre el Possum,los ratios de predicción y el score de gravedad. Pacientes: Cincuenta y dos pacientes incluidos en la lista deespera quirúrgica de nuestro centro (Hospital Universitario SanJoan de Reus) durante el periodo del 26/4/02 al 5/03/04.Resultados: el score cualitativo tiene una media superior significativaen el sexo masculino. La artropatía invalidante y los criteriossocio-laborales y/o psiquiátricos son significativamente superioresen el sexo femenino. Existe una correlación significativaentre el score de gravedad y el Possum. La edad no se correlacionaen nuestra serie con ninguna de las variables estudiadas.Conclusiones: los valores del Possum están relacionados significativamentecon el IMC, en especial en base al ratio de morbilidad.El grado de correlación entre el Possum y el score cualitativonos indica la utilidad de este para cubrir otros factoresdeterminantes en la gravedad de esta patología. Los criterios socio-laborales y psiquiátricos y la artropatía invalidante, son lasprincipales variables a tener en cuenta en la predicción postquirúrgica,estando directamente relacionados con el grado de IMC

Aim: to study a sample of patients with morbid obesity whoare on the waiting list for a surgical intervention, to establish variousscores of surgical risk (Possum and severity score), and to assesspotential criteria for list prioritization.Design: we calculated physiological and surgical Possumscores for every patient, and analysed comorbidities and other associatedfactors to calculate the severity score. Likewise, we calculatedthe predictive rates of morbimortality. Differences betweenassociated comorbidities in body mass index (BMI) were also analyzed.The correlation between Possum score, prediction rates,and severity score were analyzed.Patients: fifty-two patients on the surgical waiting list in ourinstitution (San Juan University Hospital, Reus) from 26/4/02 to5/03/04.Results: the mean qualitative score is significantly higher inthe female sex. Invalidating arthropathy and socio-occupationaland/or psychiatric criteria are significantly higher in women.There is a significant correlation between the severity score andPossum score. Age does not correlate with any of the variablesstudied.Conclusions: possum scores are significantly related to BMI,particularly in terms of morbidity rates. The degree of correlationbetween the Possum score and the qualitative score tells how usefulthe latter is to cover other determinant factors in the severity ofthis condition. Socio-occupational and psychiatric criteria, and invalidatingarthropathy are the main variables to be taken into accountfor postsurgical prediction, and are directly related to BMIdegree

Relación entre la tensión arterial y el peso seco / The relationship between blood preassure and dry weight

Este trabajo tiene como objetivo conocer cuál es la tensión arterial (TA) intradiálisis que mejor orienta sobre la obtención del "peso seco" de un paciente sometido a hemodiálisis crónica. Se ha determinado, en un grupo de 72 pacientes en hemodiálisis crónica, la TA medida ambulatoriamente: el día intermedio entre la 1ª y la 2ª sesión y entre la 2ª y 3ª sesión de hemodiálisis de la semana (cuando el paciente ha alcanzado su peso seco estimado) y se han comparado con la TA medida en distintos momentos de la sesión de hemodiálisis del día intermedio de la semana. Las mediciones de la TA se realizaron: 5 minutos antes de conectar al paciente, inmediatamente tras la conexión, cada hora durante la hemodiálisis, inmediatamente antes de la desconexión y 5 minutos después de la misma. Los resultados obtenidos difieren dependiendo de si el paciente tomaba o no medicación hipotensora. En el grupo no medicado la TA sistólica de la 2ª hora tras la conexión es la que mejor se correlaciona con su peso seco. En el grupo que tomaba medicación la TA sistólica más significativa es la de la primera hora después de la conexión. La ganancia ponderal media y el control tensional del conjunto de pacientes se consideraron adecuados (AU)

Frecuencia de la candidiasis clínica en la Unidad de Cuidados Intensivos del Hospital Universitario Ruiz y Páez: Ciudad Bolívar agosto 1996 enero 1997 / Clinical candidiasis frequency in Intensive Care Units at Universitary Ruiz y Páez

Las infecciones invasivas por candida spp son un problema serio frecuente en pacientes críticamente enfermos. Las especies de candida son un ejemplo de patógenos adquiridos en el hospital. Dentro de las áreas de alto riesgo están las Unidades de Cuidados Intensivos (UCI), donde los médicos se encuentran con frecuencia, al cuidado de pacientes con cultivos positivos para candida spp de uno o más sitios anatómicos. En la UCI del Hospital Universitario "Ruiz y Páez" no hay estudios que describan el comportamiento de esta patología y las especies involucradas. Se diseñó un estudio prospectivo, no aleatorio abierto (agosto 1996 - enero 1997), incluyendo 30 pacientes ingresados a la UCI en este período, tomándose como criterio de inclusión el haber ingresado a la UCI y criterio de exclusión que al momento del ingreso estuviese recibiendo antimicóticos. Las muestras se tomaron en los primeros 8 días del ingreso. Se recolectaron 238 muestras, 40 correspondieron a orina, 38 a exudados faríngeos, 27 a secreción traqueobronquial, 90 a hemocultivos. La frecuencia global del total de muestras recolectadas fue de 44, 11 por ciento para candida spp en los pacientes ingresados al protocolo. La especie más aislada fue C. albicans (73,3 por ciento); luego C. stellatoidea (15,23 por ciento); C. kruseii (7,61 por ciento); C. tropicalis 82,85 por ciento) y C. guillermondi (0,9 por ciento). No se encontró candidemia, durante el protocolo, sin embargo, en 2 pacientes con más de dos semanas en UCI se dectectó candidiasis sistémica. El 86,66 por ciento estaban colonizados por candida spp en al menos un sitio anatómico y el 56,66 por ciento en 3 o más sitios anatómicos. El tracto gastrointestinal fue el sitio anatómico más colonizado, el 76,66 or ciento de los pacientes presentaban entre 8 y 12 factores de riesgo para candidiasis y el 50 por ciento e ellos se clasificaron según TISS (Indice de Intervención Terapéutica) de ingreso en Clase III y el 23,33 por ciento en Clave IV. El promedio de estancia en la UCI fue de 7,06 ñ 4,7 días. Para detectar candidemia en los pacientes recluidos se necesitaría ampliar el tiempo de toma de muestra a dos semanas