[Study of the comorbidities in hospitalized patients due to decompensated chronic obstructive pulmonary disease attended in the Internal Medicine Services. ECCO Study]. / Estudio de las comorbilidades en pacientes hospitalizados por descompensación de la enfermedad pulmonar obstructiva crónica atendidos en los servicios de Medicina Interna. Estudio ECCO.

OBJECTIVE: Evaluate comorbidity in patients hospitalized due to COPD in the Internal Medicine services. METHODS: An observational, prospective and multicenter study. The Charlson index and a specific questionnaire were used. RESULTS: A total of 398 patients, 353 men (89%), with mean age of 73.7 years (8.9) and mean FEV(1) of 43.2% (12.5), were included. The most frequent comorbidities were: arterial hypertension (55%), arrhythmias (27%) and diabetes mellitus (26%). A total of 27% suffered heart failure, 17% coronary disease and 9% previous myocardial infarction. The number of associated chronic diseases was 3.6 (1,8). Score on Charlson index was 2.72 (2). CONCLUSIONS: The patients hospitalized due to decompensated COPD had an elevated comorbidity.

Estudio de las comorbilidades en pacientes hospitalizados por descompensación de la enfermedad pulmonar obstructiva crónica atendidos en los servicios de Medicina Interna. Estudio ECCO / Study of the comorbidities in hospitalized patients due to decompensated chronic obstructive pulmonary disease attended in the Internal Medicine Services. ECCO Study

ObjetivoValorar la comorbilidad en pacientes hospitalizados por enfermedad pulmonar obstructiva crónica en los servicios de Medicina Interna.MétodosEstudio observacional, prospectivo y multicéntrico. Se utilizó el índice de Charlson y un cuestionario específico.ResultadosSe incluyeron 398 pacientes, 353 varones (89%) con una edad media de 73,7 años (8,9) y volumen expiratorio máximo en el primer segundo medio del 43,2% (12,5). Las comorbilidades más frecuentes fueron hipertensión arterial (55%), arritmias (27%) y diabetes mellitus (26%). Un 27% tuvo insuficiencia cardíaca, un 17% tuvo enfermedad coronaria y un 9% tuvo infarto de miocardio previo. El número de enfermedades crónicas asociadas fue de 3,6 (1,8) y la puntuación del índice de Charlson fue de 2,72 (2).ConclusionesLos pacientes hospitalizados por descompensación de la enfermedad pulmonar obstructiva crónica tienen una comorbilidad elevada(AU)

ObjectiveEvaluate comorbidity in patients hospitalized due to COPD in the Internal Medicine services.MethodsAn observational, prospective and multicenter study. The Charlson index and a specific questionnaire were used.ResultsA total of 398 patients, 353 men (89%), with mean age of 73.7 years (8.9) and mean FEV1 of 43.2% (12.5), were included. The most frequent comorbidities were: arterial hypertension (55%), arrhythmias (27%) and diabetes mellitus (26%). A total of 27% suffered heart failure, 17% coronary disease and 9% previous myocardial infarction. The number of associated chronic diseases was 3.6 (1,8). Score on Charlson index was 2.72 (2).ConclusionsThe patients hospitalized due to decompensated COPD had an elevated comorbidity(AU)

Análisis de residuos de herbicidas en aguas procedentes de Navarra mediante lc-ms/ms / Lc-ms/ms analysis of herbicide residues in waters from Navarre

Fundamento. El objetivo del trabajo fue obtener informaciónacerca de los residuos de herbicidas (imazametabenz,simazina, isoproturon, clortoluron, metribuzina,atrazina, cianazina, terbutrina, propanil,terbutilazina, alacloro y pendimetalina) presentes enaguas procedentes de Navarra.Material y métodos. Se tomó un total de 465 muestrasde agua; de ellas, 378 se obtuvieron en 141 abastecimientos;las 87 restantes procedieron de 37 fuentes,manantiales y sondeos situados en zonas agrícolas delsur de Navarra. La técnica empleada fue LC-MS/MS.Resultados. Se detectaron residuos de herbicidas en el33% de los abastecimientos, y su concentración superóel límite normativo en el 8% de ellos. Se encontraron residuosde herbicidas en el 86% de las muestras de pozos yfuentes de zonas agrícolas del sur de Navarra. El númerode abastecimientos con residuos de herbicidas aumentóde norte a sur de Navarra. No obstante, el porcentaje deabastecimientos en los que la concentración de herbicidassuperó los límites fue mayor en la zona centro de Navarraque en la zona sur y norte. Imazametabenz fue el herbicidamás detectado en las muestras de las zonas norte, centro ysur. Atrazina, terbutilazina e imazametabenz se detectaronpreferentemente en las muestras de la zona sur.Conclusiones. Las diferencias entre las tres zonas deNavarra pueden explicarse atendiendo a las diferentesprácticas agrícolas de cada región. No se detectaronconcentraciones de herbicidas superiores a los límitesnormativos en ninguna de las muestras de agua procedentesde las poblaciones mayoritarias de Navarra(AU)

Background. The aim of the study was to obtain informationon the residues of herbicides (imazametabenz,simazine, isoproturon, clortoluron, metribuzine, atrazine,cianazine, terbutrin, propanil, terbutilazine, alachlorand pendimetalin) present in water proceedingfrom Navarre.Material and methods. A total of 465 samples of waterwere taken: 378 were taken from 141 water supplies; theremaining 87 proceeded from fountains, springs and boringsin agricultural areas in the south of Navarre. Thetechnique employed was LC-MS/MS.Results. Herbicide residues were detected in 33% of thewater supplies, and their concentration exceeded thenormative limit in 8% of them. Herbicide residues werefound in 86% of the samples from wells and fountains ofthe agricultural areas of the south of Navarre. The numberof water supplies with herbicide residues increased fromnorth to south. However, the percentage of water suppliesin which the concentration of herbicides exceeded the limitswas greater in the centre of Navarre than in the northand south. Imazametabenz was the herbicide most detectedin the samples from the northern, central and southernareas. Atrazine, terbutilazine and imazametabenz weremost detected in the samples of the southern area.Conclusions. The differences amongst the three areasof Navarre can be explained as being due to the differentagricultural practices of each area. Concentrationsof herbicides exceeding the normative limits were notdetected in any of the water samples proceeding fromthe larger towns of Navarre(AU)

[LC-MS/MS analysis of herbicide residues in waters from Navarre]. / Análisis de residuos de herbicidas en aguas procedentes de Navarra mediante LC-MS/MS.

BACKGROUND: The aim of the study was to obtain information on the residues of herbicides (imazametabenz, simazine, isoproturon, clortoluron, metribuzine, atrazine, cianazine, terbutrin, propanil, terbutilazine, alachlor and pendimetalin) present in water proceeding from Navarre. MATERIAL AND METHODS: A total of 465 samples of water were taken: 378 were taken from 141 water supplies; the remaining 87 proceeded from fountains, springs and borings in agricultural areas in the south of Navarre. The technique employed was LC-MS/MS. RESULTS: Herbicide residues were detected in 33% of the water supplies, and their concentration exceeded the normative limit in 8% of them. Herbicide residues were found in 86% of the samples from wells and fountains of the agricultural areas of the south of Navarre. The number of water supplies with herbicide residues increased from north to south. However, the percentage of water supplies in which the concentration of herbicides exceeded the limits was greater in the centre of Navarre than in the north and south. Imazametabenz was the herbicide most detected in the samples from the northern, central and southern areas. Atrazine, terbutilazine and imazametabenz were most detected in the samples of the southern area. CONCLUSIONS: The differences amongst the three areas of Navarre can be explained as being due to the different agricultural practices of each area. Concentrations of herbicides exceeding the normative limits were not detected in any of the water samples proceeding from the larger towns of Navarre.

[Analysis of causes of excessive prehospital delay of patients with acute myocardial infarction in the province of Teruel]. / Análisis de las causas que motivan una excesiva demora prehospitalaria de pacientes con infarto agudo de miocardio en la provincia de Teruel.

BACKGROUND: To analyze the delay of patients who come to the hospital and are diagnosed with acute myocardial infarction, its causes and the variables with determine it. PATIENTS, MATERIAL AND METHODS: Prospective study of 115 patients (79 male and 36 female). The pre-hospital delay time was measured as the time which passed from the moment when the patient feels the first symptoms "chest pain", until his arrival and registration at the Emergency Service. This time was divided into three subdivisions: decision time, medical time and transport time. We determined: place of origin, indications and means of transport used to reach the hospital, diagnosis and treatment given by the general practitioner before arrival at the hospital, the cardiovascular risk factors, location of patients pain, the time of day and the delay at the Emergency Service. RESULTS: The mean pre-hospital delay was 364 +/- 534 min (median of 195 min). Most of the patients (73.7%) came to hospital during the first six hours. The major part of total delay corresponded to the decision delay (202 +/- 363 min with a median of 75), which occupied 50.1% of the whole (confidence interval 95% [CI 95%], 44.6-55.6%), while the transport time occupied 34.6% (CI 95%, of 30.1-39%) with a median of 50 min. Major pre-hospital delay corresponded to the patients coming from rural areas (p = 0.007), to those asked for medical assistance (p = 0.0029), to diabetics (p = 0.01) and to those who felt the pain during their night sleep (p = 0.0023). Transport time was negatively influenced by old age (p = 0.0012), rural origin (p = 0.0001), the appearance of the night sleep pain (p = 0.031) and calling the general practitioner for first aid (p = 0.0001), but it was not influenced by the form of transport used to get to the hospital. The intra-hospital delay time had an median of 60 min, being longer for older people (p = 0.007), for patients with hypertension (p = 0.014) and those who were admitted from the Intensive Care Unit (p = 0.0001). CONCLUSIONS: The pre-hospital delay detected in our environment is longer than other studies and confirms that half of it is not due to the intrinsic functioning of our health system, even through it should get involved as much as possible to diminish the delay time.

[Delay time to arrive at the hospital of 275 patients with acute myocardial infarction. Study form the province of Teruel (1991-1994)]. / Tiempo de demora en acudir al hospital de 275 pacientes con infarto agudo de miocardio. Análisis de la provincia de Teruel (1991-1994).

BACKGROUND: To study the delay time to arrive of the hospital and its relation with any variables, of patients with acute myocardial infarction from the province of Teruel (Spain). PATIENTS AND METHODS: A prospective study was carried out from January 1991 to October 1994. We included patients who were diagnosticated of the acute myocardial infarction (212 men and 63 women). We considered the time between the thoracic pain and their arrive at the urgency service. We based the diagnosis in clinical, electrocardiographic and enzymatic criteria. RESULTS: The mean delay time was 8 h 46 m. The 66.5% arrives before 6 hours. We found no differences between rural or urban patients. The delay time was minor in men than women (7 h 12 m versus 14 h, p = 0.0019), in younger (< 65 years old) than in the older (6 h 3 m versus 10 h 18 m, p = 0.0278), and in those who were admitted to the ICU (7h 16 m versus 20 h 33 m, p = 0.0001). Was longer in patients with arterial hypertension and diabetes. Was minor in patients with dyslipemia and tobacco habit. Many patients to arrive of the hospital by physician order and with own vehicles, it took less time arrive at the hospital than by ambulance (8 h 30 m versus 18 h, p < 0.05). The medium delay in the emergency area was 2 h 35 m. The delay time was longer in patients who died (16 h versus 7h 30 m, p = 0.0018) and in those who present more frequently cardiac failure. CONCLUSIONS: The mean delay time to arrive at the hospital in patients with acute myocardial infarction from the province of Teruel (Spain) in unreasonable and in takes a poor prognosis, so we consider necessary to study the causes of this delay in order to correct them.

Increased activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger in erythrocytes of patients with essential hypertension.

OBJECTIVE: To study the activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger in erythrocytes of patients with essential hypertension. DESIGN: The study was performed in cells from 48 untreated essential hypertensive patients and 30 normotensive controls with similar age- and sex- distribution. METHODS: The activity of the Na(+)-dependent anion exchanger was determined by measuring the 4,4'-diisothiocyanostilbene-2,2'-disulfonate (DIDS) sensitive Li+ influx in fresh cells incubated into a medium containing Li2CO3. RESULTS: The DIDS-sensitive Li+ influx was higher in hypertensives than controls. With the 100% confidence (upper) limit of the normotensive population as a cut-off point, a subgroup of 11 hypertensives had an abnormally high activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger. Compared with patients with normal exchanger activity, patients with increased exchanger activity were characterized by the following: higher frequency of family history of hypertension; lower serum high-density lipoprotein cholesterol levels and higher plasma aldosterone concentrations. After multiple regression analysis, the DIDS-sensitive Li+ influx was inversely correlated with high-density lipoprotein cholesterol levels. CONCLUSIONS: These results show the presence of a new abnormality of erythrocyte Na+ transport in essential hypertension--increased activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger. In addition, our findings suggest that from the clinical point of view, patients with this transport abnormality represent a particular subset of essential hypertensives.

[Diagnostic value of anesthesia for the surgery of strabismus]. / Der diagnosticsche Wert der Anästhesie für die Chirurgie des Strabismus.

There is no clinical test to detect a blockade. Under Anesthesia it is possible to discover a suspected blockade, so this test is quite helpful. Even in small babies this test can be applied in order to dected a pseudoparalysis of the external recti. We decide to operate after evaluation of the clinical facts and the findings under anesthesia according to the Zato test. We especially observe the positions of the eyes during normal breathing and the position under deep anesthesia.