Evolución de la capacidad funcional en personas mayores en programa de atención domiciliaria y evaluación de factores predictivos de mortalidad / Evolution of functional ability in older people under home care program and evaluation of predictive mortality factors

Objetivos: Los objetivos del estudio fueron determinar la evolución de la capacidad funcional en mayores de 65 años de la Región Sanitaria de Lleida durante su estancia en el programa de atención domiciliaria (ATDOM), y analizar los factores predictores de mortalidad Metodología: Se trata de un estudio longitudinal. La muestra incluye las estancias (procesos) ≥ 6 meses en el programa ATDOM ocurridos durante 5 años. Las variables a estudio fueron la capacidad funcional al ingreso, a la mitad y al final del proceso, las características sociodemográficas, las enfermedades crónicas, el estado de salud, los problemas sociofamiliares y la mortalidad Resultados: Se incluyeron un total de 8.189 personas, con un total de 8.433 procesos abiertos entre los años 2011 y 2016. La capacidad funcional empeoró más en las primeras fases del proceso, y se mantuvo más estable en la fase final. En las personas más mayores, con demencia senil y con presencia de úlceras por presión, la dependencia aumentaba conforme avanzaba el proceso. Conclusiones: Los resultados obtenidos en este estudio sobre la relación de la dependencia funcional en la valoración inicial y el mayor riesgo de mortalidad son coincidentes con estudios desarrollados (AU)

Objectives: The objective of the study was to determine the evolution of functional ability in patients over 65 years of age during the home care program in the Lleida Health Region and analyze the predictors of mortality. Methodology: The sample includes stays in the home care program (processes) of at least six months long over five years. The variables under study were functional ability at the beginning, in the middle, and at the end of the process, sociodemographic characteristics, chronic diseases, health status, socio-family problems, and mortality. Results: A total of 8,189 people were included with a total of 8,433 processes opened between the years 2011 and 2016. Functional ability worsened more in the early stages of the process, remaining more stable in the final phase. In older patients, with senile dementia and the presence of pressure ulcers, dependence increased as the process progressed. Conclusions: The results obtained in this study on the relationship of functional ability in the initial assessment and the increased risk of mortality are consistent with studies carried out (AU)

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Post mortem tryptase cut-off level for anaphylactic death.

Serum mast cell tryptase is used to support the diagnosis of anaphylaxis. The recommended clinical cut-off for total tryptase (<11.4µg/L) appears unsuitable in the post mortem setting due to largely unknown processes which result in significantly elevated levels in these samples. Consequently there is no widely accepted tryptase cut-off level for diagnosing an anaphylactic death. This 5-year retrospective study compared total tryptase levels in post mortem femoral blood in anaphylactic deaths and control. Univariate and multivariate analysis was used to assess the relative contribution of other factors (age, gender, post mortem interval, and presence of resuscitation) on post mortem tryptase levels. Nine anaphylactic deaths and 45 controls were identified. Receiver-operating characteristic (ROC) curve analysis identified an optimal cut-off of 53.8µg/L, with sensitivity of 89%, and specificity of 93%, for total post mortem tryptase in femoral blood to diagnosis anaphylaxis. No other factors showed any statistical significant contribution to post mortem tryptase elevation. Femoral total post mortem tryptase level of 53.8µg/L and above is a useful ancillary test in diagnosing an anaphylactic death.

Post mortem vitreous magnesium in adult population.

BACKGROUND: The study of post mortem vitreous magnesium (Mg) is less common than sodium (Na), chloride (Cl) and potassium (K) in the forensic literature. There is no accepted normal range for post mortem vitreous Mg and the relationship between post mortem vitreous Mg levels and post mortem interval (PMI), other electrolyte levels, disease conditions, age and sex have not been fully established. AIM: To investigate the relationship of post mortem vitreous Mg with age, sex, PMI, vitreous electrolyte levels and diabetic status. METHODS: A retrospective study of 20 consecutive cases of diabetics and 20 non-diabetic adult deaths was performed. Spearman correlation and the permutation test were used to explore the relationship between post mortem vitreous Mg and continuous and categorical variables respectively. RESULTS: The mean post mortem vitreous Mg was 1.03mmol/L (95%CI: 0.98-1.08mmol/L). The absolute Spearman correlation coefficients (rho) between post mortem vitreous Mg with PMI, age, and other vitreous electrolytes (Na, Cl, and K) ranged between 0.04-0.21 (p>0.19). Post mortem vitreous Mg was statistically higher in diabetics (mean difference: 0.08mmol/L; area-under-the-curve=0.65 on receiver-operator-characteristic curve). No statistical difference was demonstrated between sexes (p=0.92). CONCLUSIONS: In our adult population, post mortem vitreous Mg did not correlate with age, PMI, other vitreous electrolytes (sodium, chloride and potassium) or sex. It was higher in diabetics, however had limited utility as a surrogate marker. Overall, post mortem Mg is steady in the early post mortem period with a mean of 1.03mmol/L.

Differences in sampling techniques on total post-mortem tryptase.

BACKGROUND: The measurement of mast cell tryptase is commonly used to support the diagnosis of anaphylaxis. In the post-mortem setting, the literature recommends sampling from peripheral blood sources (femoral blood) but does not specify the exact sampling technique. Sampling techniques vary between pathologists, and it is unclear whether different sampling techniques have any impact on post-mortem tryptase levels. AIM: The aim of this study is to compare the difference in femoral total post-mortem tryptase levels between two sampling techniques. METHODS: A 6-month retrospective study comparing femoral total post-mortem tryptase levels between (1) aspirating femoral vessels with a needle and syringe prior to evisceration and (2) femoral vein cut down during evisceration. RESULTS: Twenty cases were identified, with three cases excluded from analysis. There was a statistically significant difference (paired t test, p < 0.05) between mean post-mortem tryptase by aspiration (10.87 ug/L) and by cut down (14.15 ug/L). The mean difference between the two methods was 3.28 ug/L (median, 1.4 ug/L; min, - 6.1 ug/L; max, 16.5 ug/L; 95% CI, 0.001-6.564 ug/L). CONCLUSIONS: Femoral total post-mortem tryptase is significantly different, albeit by a small amount, between the two sampling methods. The clinical significance of this finding and what factors may contribute to it are unclear. When requesting post-mortem tryptase, the pathologist should consider documenting the exact blood collection site and method used for collection. In addition, blood samples acquired by different techniques should not be mixed together and should be analyzed separately if possible.

Elevation of post mortem vitreous humour sodium and chloride levels can be used as a reliable test in cases of suspected salt water drowning when the immersion times are less than one hour.

BACKGROUND: Previous studies in salt water drowning deaths (SWD) demonstrated an observable elevation of post mortem vitreous sodium and chloride (PMVSC) levels. It remains unclear what the underlying mechanism responsible for this change is: whether this is due to rapid electrolyte changes from salt water inhalation/ingestion during drowning or from electrolyte diffusion and/or osmosis across the outer coats of the eyeballs during immersion. A recent animal study using sacrificed bovine eyeballs immersed in salt water demonstrated no significant elevations in PMVSC when immersed for less than one hour. Assuming similar physical properties between human and bovine, we extrapolate that an elevation in PMVSC in SWD with immersion times of less than one hour (SWD-1) would not be from immersion, but from drowning. AIM: Investigate whether there is an elevation in PMVSC in SWD-1. METHODS: Retrospective study comparing PMVSC in SWD-1 with controls from 2012 to 2015 inclusive. RESULTS: PMVSC in SWD-1 was significantly elevated compared with controls. A PMVSC of 259mmol/L has a sensitivity, specificity and likelihood ratio of 0.9, 0.9 and 7.6, respectively. CONCLUSION: The elevation in PMVSC in SWD-1 is due to drowning. A PMVSC of 259mmol/L and above is a reliable ancillary test in diagnosing drowning in bodies immersed in salt water for less than one hour.

In vitro anthelmintic effect of Melia azedarach L. and Trichilia claussenii C. against sheep gastrointestinal nematodes.

The control of parasitic diseases in small ruminants is mainly done with the use of synthetic anthelmintics. However, incorrect and indiscriminate use of these products has caused the emergence of parasite resistance. Plants with anthelmintic activity are used in folk veterinary medicine, but it is necessary to investigate and scientifically validate low-cost phytotherapeutic alternatives for future use to control gastrointestinal nematodes in small ruminants by family farmers. Thus, the aim of this study was to evaluate the in vitro anthelmintic effect of plant extracts from Melia azedarach and Trichilia claussenii by the egg hatch test (EHT) and larval development test (LDT) against sheep gastrointestinal nematodes. The hexane extract of M. azedarach fruits was extracted through cold percolation and the methanol extract of T. claussenii leaves was obtained by extraction at room temperature in solvents in order of increasing polarity. The efficacy results were analyzed using the Probit program of SAS. The M. azedarach extract showed a LC(50) of 572.2 µg/mL and LC(99) of 1137.8 µg/mL in the EHT, and LC(50) of 0.7 µg/mL and LC(99) of 60.8 µg/mL in the LDT. In turn, the T. claussenii extract presented a LC(50) of 263.8 µg/mL and LC(99) of 522.5 µg/mL in the EHT and LC(50) of 1.1 µg/mL and LC(99) of 26.4 µg/mL in the LDT. Comparing the extracts of the species from the Meliaceae family, T. claussenii showed greater anti-parasite potential in vitro than M. azedarach. However, studies on the isolated compounds, toxicity and administration forms to animals are also needed to validate low-cost alternative herbal remedies for use to control gastrointestinal nematodes by family farmers.

Previous cycling does not affect running efficiency during a triathlon world cup competition.

AIM: The most strategic part of a triathlon is the cycle-run transition. However, all the studies about this situation have been carried out in laboratory conditions and there is a need to perform this kind of study during competition, when the triathletes are highly motivated and the effort is maximum.1 Therefore, the aims of the present study were: 1) to determine the effect of prior 40-km cycling on the 10-km running kinematics during a Triathlon World Cup competition, and 2) to examine the possible differences between males and females. METHODS: Ten men and ten women, selected among the first ten competitors at the end of the cycling part at Madrid 2006 BG Triathlon World Cup, were enrolled in the study. The kinematic analysis was carried out using a photogrammetric technique (DLT algorithms) in the saggital plane (2D). RESULTS: There are significant differences (P<0.05) in men's stride length and velocity between the first and the last lap. Also, significant differences (P<0.05) were found between men and women in many of the variables analyzed. CONCLUSIONS: The previous cycling does not affect the subsequent running efficiency during a elite triathlon competition. On the other hand, the running technique profile during a triathlon competition is very different between men and women.

Unusual presentation of pulmonary tumor thrombotic microangiopathy with no detectable primary tumor.

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition characterized by the presence of diffuse thrombotic microthrombi and fibrocellular intimal proliferation in the pulmonary vasculature. Its development is linked to the presence of pulmonary tumor microemboli (PTM) and should be suspected in patients with unexplained dyspnea, especially in the presence of adenocarcinoma. PTTM presents in a similar fashion to respiratory disease such as pulmonary embolism, pulmonary hypertension or pneumonia and is usually only diagnosed post-mortem. We report a case of PTTM identified ante-mortem by bronchial biopsy in an 82-year-old woman presenting with a clinical picture of atypical pneumonia. Autopsy confirmed PTTM, from an unknown primary neoplasm.

Enfermería los nuevos modelos de salud / Nursing and new health models

En los últimos años estamos viendo como los sistemas de salud sufren importantes cambios: satisfacción del cliente, mayor accesibilidad a los servicios, nuevo enfoque de los hospitales, multiplicación de las disciplinas, aumento de la tecnología, envejecimiento de la población, aumento de los costos, etc. Estos cambios constituyen un desafío importante para enfermería exigiéndole cada vez más técnicas de valoración, planes de cuidados estandarizados, trayectorias clínicas etc. En definitiva enfermeras bien preparadas que ahorren tiempo y que garanticen caí ¡dad en sus servicios. Para encajar en estos cambios es importante que Enfermería conozca las nuevas tendencias y los nuevos modelos de salud y reflexione sobre el futuro de la profesión y los retos que nos depara el mercado laboral (AU)

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An unusual foreign body in the distal small intestine: case report.

A case of a deceased 77-year-old woman presenting to the coroner for postmortem examination scribed. A plastic tie used to seal loaves of sliced bread and other plastic-wrapped food stuffs was found clamped by its "teeth" to a length of small bowel proximal to the cecum, resulting in localized mucosal ulceration, thickening, and edema of the bowel wall. There was also infarcted small bowel due to aortic atherosclerosis, which was submitted as the cause of death. The presence of the bread tie probably did not significantly contribute to death but was as an unusual finding at postmortem examination and has not been previously described.

Thromboxane biosynthesis, neutrophil and coagulative activation in type IIa hypercholesterolemia.

Thromboxane (Tx) A2 biosynthesis is enhanced in the majority of patients with type IIa hypercholesterolemia. Because blood clotting activation is an important component of the inflammatory response, involved in the initiation and progression of atherosclerotic plaques, we have investigated TxA2 biosynthesis, neutrophil activation and thrombin generation in 24 patients with type IIa hypercholesterolemia. Urinary 11-dehydro-TxB2, was significantly higher (p = 0.0001) in patients than in 24 sex- and age matched healthy subjects. Similarly, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III complexes and plasma elastase were significantly higher in patients than in controls. Urinary 11-dehydro-TxB2 excretion was correlated with plasma elastase (r = 0.758; p = 0.0001), and prothrombin fragment 1 + 2 (r = 0.804; p = 0.001). The enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor simvastatin (20 mg/day for 2 months) significantly reduced cholesterol levels, urinary 11-dehydro-TxB2 excretion, plasma elastase and plasma F1 + 2 in 8 patients. We conclude that type IIa hypercholesterolemia is associated with biochemical evidence of platelet, neutrophil and blood clotting activation. The relationship between these events remains to be investigated.

Platelet aggregation, ATP release and cytoplasmic Ca2+ movement: the effects of cloricromene.

A placebo-controlled, double-blind, randomized, cross-over study was performed in 24 healthy volunteers. 12 volunteers received Cloricromene (100mg gastroresistant capsules twice a day) for 7 days, the other volunteers received identical placebo capsules. Subsequently, after a 7-day wash-out period, at day 15, each subject received the other treatment. Blood samples were taken on days 1 and 15 (1st day of each treatment) as well as on days 7 and 21 (7th day of each treatment) before the morning drug administration and 2 and 4 hours later. Platelet aggregation and ATP secretion were studied in whole blood (WB) using ADP and collagen as stimulating agents. Ca2+ fluxes were studied in aequorin-loaded, washed platelets stimulated with ADP and collagen, while aggregation in platelet-rich plasma (PRP) was studied using PAF, ADP and adrenaline as agonists. Consistent inhibition of aggregation and release induced by both ADP and collagen was observed in WB after Cloricromene administration. Similarly, Ca2+ flux was also inhibited after drug administration. Platelet aggregation in PRP was inhibited only after 7 days of Cloricromene treatment with ADP and adrenaline as stimuli. We conclude that oral administration of Cloricromene leads to significant antiplatelet activity in healthy volunteers, in particular when platelets are studied in the presence of other blood elements.

Massive proteinuria and its effects on renal tubular functions.

Studies of renal tubular functions were made in two groups of patients with biopsy-proven primary glomerulonephropathies to assess the effects of proteinuria on the tubules. Group I (n = 9) had had minimal proteinuria and Group II (n = 8) had massive proteinuria. At the time the studies were made, all patients were normotensive, free of oedema, and on no dietary or drug therapy; they had normal glomerular filtration rates, serum albumin and total protein concentrations. Patients in Group II had diminished urine concentrating ability, impaired acidifying mechanism, but elevated maximum tubular secretory capacity compared with patients in Group I.