Adolescent ethanol intake alters cannabinoid type-1 receptor localization in astrocytes of the adult mouse hippocampus.

Cannabinoid type-1 (CB1 ) receptors are widely distributed in the brain and play important roles in astrocyte function and the modulation of neuronal synaptic transmission and plasticity. However, it is currently unknown how CB1 receptor expression in astrocytes is affected by long-term exposure to stressors. Here we examined CB1 receptors in astrocytes of ethanol (EtOH)-exposed adolescent mice to determine its effect on CB1 receptor localization and density in adult brain. 4-8-week-old male mice were exposed to 20 percent EtOH over a period of 4 weeks, and receptor localization was examined after 4 weeks in the hippocampal CA1 stratum radiatum by pre-embedding immunoelectron microscopy. Our results revealed a significant reduction in CB1 receptor immunoparticles in astrocytic processes of EtOH-exposed mice when compared with controls (positive astrocyte elements: 21.50 ± 2.80 percent versus 37.22 ± 3.12 percent, respectively), as well as a reduction in particle density (0.24 ± 0.02 versus 0.35 ± 0.02 particles/µm). The majority of CB1 receptor metal particles were in the range of 400-1200 nm from synaptic terminals in both control and EtOH. Altogether, the decrease in the CB1 receptor expression in hippocampal astrocytes of adult mice exposed to EtOH during adolescence reveals a long lasting effect of EtOH on astrocytic CB1 receptors. This deficiency may also have negative consequences for synaptic function.

Latrodectismo. Caso clínico y revisión de la literatura / Latrodectism Case report and review of literature

El latrodectismo es un cuadro clínico causado por la mordedura de una araña del género Latrodectus spp., ampliamente distribuido en todo Chile continental. Generalmente las mordeduras se asocian a faenas agrícolas. El veneno del género Latrodectus contiene α-latrotoxina, una neurotoxina que actúa a nivel presináptico del sistema nervioso autónomo aumentando la liberación de acetilcolina. El cuadro clínico es inespecífico y hasta en un tercio de los casos ocurren síntomas sistémicos. El diagnóstico es clínico y depende del antecedente de la mordedura por una araña con un cuadro clínico compatible. El pronóstico es favorable: se reporta una letalidad entre 0 y 6 por ciento. El manejo es esencialmente sintomático, principalmente analgésico. Presentamos el caso de un hombre de 62 años, proveniente de Santa Cruz, VI región, trabajador en una plantación de trigo. Consultapor dolor torácico asociado a mialgias generalizadas y diaforesis. Por sospecha de latrodectismo, se administra neostigmina con buena respuesta clínica.(AU)

Latrodectism is a clinical entity caused by the bite of a spider of the genus Latrodectus spp. widely distributed throughout continental Chile. Generally, bites are associated with agricultural activities. The venom of spiders of the genus Latrodectus contains α-latrotoxin, a neurotoxin that acts at the presynaptic level of the autonomic nervous system, this way increases the release of acetylcholine. The clinical manifestations are non-specific and systemic symptoms occur in up to one-third of the cases. The diagnosis is clinical and depends on the history of being bitten by a spider with a compatible clinical presentation. The prognosis is favorable: a lethality between 0 and 6 percent has been reported. The clinical management is essentially symptomatic, mainly analgesic. We present the case of a 62-year-old man from Santa Cruz, VI region, working in a wheat farm. He attends the emergency service with chest pain associated with generalized myalgias and diaphoresis. On suspicion of latrodectism, neostigmine is administered with goodclinical response. (AU)

Percepción de seguridad clínica entre profesionales y pacientes de cirugía cardiaca / No disponible

Objetivos: Determinar la satisfacción y percepción del riesgo clínico de los pacientes de un servicio de cirugía cardiaca. Evaluar el clima de seguridad clínico entre los profesionales del mismo área. Material y método: Estudio descriptivo mediante encuesta anónima y autocumplimentada a pacientes ingresados en el servicio de cirugía cardiaca del Complejo Hospitalario de Toledo, y estudio transversal mediante encuesta a profesionales (versión española del Hospital Survey on Patient Safety Culture). Análisis estadístico mediante el programa SPSS. 12. Y valoración cualitativa de los comentarios. El proyecto fue aprobado por el Comité de ética de investigación clínica del centro. Resultados: Se han analizado 203 encuestas a pacientes (cobertura= 56%). La media de edad fue de 66,03 años (D.E= 10,83), el 38,1% fueron mujeres y el 61,9% varones. El 96,5% afirma conocer el nombre del cirujano que le operó y el 48,6% afirma conocer el nombre de alguna de las enfermeras del Servicio. Afirman haber tenido “casi siempre” o “siempre” dolor en la herida quirúrgica el 16,9% y dolor de garganta posquirúrgico el 26,3%. El 98,4% cree que le explicaron con claridad su evolución “casi siempre” o “siempre”. El 95,1% “cree que el servicio da a los pacientes una atención segura” y el 99% afirma que sí recomendaría éste. El 1,6% opina que en el hospital le han hecho pruebas sin su permiso. Existen diferencias significativas (p=0,045) al comparar las medidas en la escala numérica de satisfacción global, entre pacientes que conocen el nombre del cirujano (9,27), y los que afirman no conocerlo (7,64). En la encuesta a profesionales, la cobertura fue del 77%. El 50% cree que se busca un “culpable” antes de buscarse la causa de un error. Sobre la escala de 0 a 10 que evalúa el grado de seguridad clínica en el Servicio, el 95% marcó por encima de 4. Conclusiones: La mayoría de los pacientes ingresados en el Servicio de Cirugía Cardiaca cree que recibió una atención segura y una información adecuada, si bien existen todavía áreas de mejora. La mayoría de los profesionales del área valora la seguridad del paciente en su Servicio entre “aceptable” y “muy buena” (AU)

Objectives: To determine the “patients risk perception and satisfaction” at the Department of Cardiac Surgery. To assess the patient safety cultures among professionals this area. Methods: Descriptive study through a survey of patients admitted at the Department of Cardiac Surgery and a cross-sectionaly study by a survey (Spanish version of the Hospital Survey on Patient Safety Culture). Results: We analyzed 203 surveys of patients (56% coverage). The mean age was 66.03 years (SD = 10.83), 38,1% were women and 61,9% men. 96,5% knew the name of the surgeon and 48,6% the name of one of the nurses of the service. 16,9% claimed to have had “almost always” or “Always” pain at the surgical wound and 26,3% had a sore throat after surgery. 98.4% of them believed that “almost always” of “always” they had been provide with adequate information. 95,1% believe that they received attention without risk in the Department of Cardiac Surgery and 99% said that they would recommend the sevice to others. 1,6% felt that the hospital had done tests without their permission. There are significant differences (p=0.045) when comparing the average number on the scale of overall satisfaction, between patients who know the name of the surgeon (9.27) and those who claim do not to know it (7.64). 20 staff members answered the survey (77% coverage). 50% of them think that someone the blame is “looked for” first, instead of seeking for the cause of and error. Over the visual scale from zero to ten to assess the grade of patient safety in the department, 95% marked over 4. Conclusions: Most of the patients admitted to the Cardiac Surgery service believe that they received a safe health care, although there are still areas for improvement. Most professionals at the Department valued patient safety between “acceptable” and “very good” (AU)

Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis.

The aim of this study was to analyze medical outcomes, including risks for complications and mortality, in 332 adult patients hospitalized for cellulitis. The infection was documented microbiologically in 128 cases (39%). Staphylococcus aureus (46 cases) and Streptococcus pyogenes (22 cases) were the most frequent causative pathogens. Overall, 63 patients (19%) were discharged early (< or =4 days) and 166 patients (50%) were hospitalized for more than 4 days without developing any complications. One hundred three patients (31%) had one or more complications or died. Of these, 78 required surgical debridement, 10 required plastic surgery, 7 underwent amputation, and 15 had shock on presentation. When comparing the three study groups (patients discharged early, patients hospitalized for < or =4 days without complications, and patients who developed 1 or more complication or who died), patients who were discharged early (low risk) were more frequently female and were less likely to have multiple comorbid conditions, hypoalbuminemia, renal insufficiency, and/or cutaneous necrosis at presentation. Overall mortality (<30 days) was 5% (16/332 patients). Factors associated with death were male sex, presence of multiple comorbid conditions, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency, shock, and Pseudomonas aeruginosa cellulitis. These findings can be used to stratify patients with acute cellulitis according to risks for complications and mortality and may be helpful when deciding the most appropriate means of care, i.e. outpatient treatment or hospitalization.

[Analysis of the scales of measures, the efficacy of the treatments and the health/social impact of Alzheimer disease in the Basque Country, Spain]. / Análisis de las escalas de medición, eficacia de los tratamientos e impacto sociosanitario de la enfermedad de Alzheimer en el País Vasco.

BACKGROUND: The purpose of this study is to review the clinical analyses regarding efficacy of the different drugs used in the treatment of Alzheimer, across distinct scales of measures in order out the progression of the Alzheimer's Disease (AD). Along with this an economic analysis of the health/social impact of this illness in the Basque Country has been carried out. METHODS: A selection and synthesis of the relevant scientific evidence was made by means of a bibliographical research in the main data bases (Medline, Embase, Cross, Iowa Drug Information System, Healthstar and The Cochrane Library). The value of the costs was carried out from a social perspective. During 1998 a health social costs analysis of this pathology was undertaken in the Basque Country, Spain, starting from a table of assumptions. RESULTS: ADAS and PDS are the only cognitive and functional scales developed and validated specifically for the AD. The drugs specifically prescribed for the AD (tacrine, donepezil, and revastigmine) contribute a slight benefit, whose clinical meaning is unknown. During 1998 the global cost of treating the AD in the Basque Country has been at least 55,858 million pesetas (US$ 360.5 millions dollars). The social cost (nursing homes, day centres, home help, help from family and friends) comes to represent 98.4% of this global cost. CONCLUSIONS: At the moment, there is not any effective drug in the treatment of the AD. The informal cost (help from family and friends) comes to represent 88.4% of the total social costs.

Analysis of responses to kallidin, DABK, and DAK in feline hindlimb vascular bed.

Responses to kallidin, des-Arg9-bradykinin (DABK), and des-Arg10-kallidin (DAK) were investigated in the hindlimb vascular bed of the cat under constant-flow conditions. Injections of kallidin, DABK, and DAK into the hindlimb perfusion circuit produced dose-dependent vasodilator responses in the hindlimb vascular bed. Vasodilator responses to kallidin and bradykinin (BK) were similar in magnitude and time course, and both peptides were approximately 100-fold more potent than DABK or DAK. Responses to kallidin were decreased by the kinin B2 antagonist, HOE 140, whereas responses to DABK and DAK were reduced by des-Arg9[Leu8]BK, a kinin B1-receptor antagonist. N omega-nitro-L-arginine methyl ester (L-NAME) reduced vasodilator responses to kallidin, DABK, and DAK, whereas meclofenamate, atropine, and U-37883A, a vascular selective ATP-sensitive K+ (K+ATP) channel-blocking agent, did not alter responses to the three peptides. These data suggest that both kinin B1 and B2 receptors are normally present in the hindlimb vascular bed. These data also suggest that kinin B1 and B2 receptor-mediated vasodilator responses are mediated by the release of nitric oxide and that the activation of K+ATP channels or muscarinic receptors, or the release of vasodilator prostaglandins play little if any role in mediating responses to kallidin, DABK, or DAK in the hindlimb vascular bed of the cat.