Use of healthcare REsources and associated COsts in controlled versus uncontrolled carcinoid SYndrome in patients with neuroendocrine tumours: the RECOSY study.

PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22; P = 0.028) and ED costs (€161.25 vs €14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.

Sistema penitenciario y vejez: aportes de la evaluación neuropsicológica forense / Penitentiary System and old age: contributions of the forensic neuropsychological evaluation

Resumen Introducción: El envejecimiento poblacional ha impulsado a que su abordaje se convierta en un tema prioritario a nivel mundial, sobre la cual aún existen mitos y discriminación, siendo las personas adultas mayores en privación de libertad en un sistema penitenciario, una población con mayores riesgos de exclusión y que cuentan con características neuropsicológicas que ameritan su atención. Por lo tanto, se realizó en Costa Rica un primer abordaje en el Centro de Atención Institucional Adulto Mayor desde la neuropsicología forense, para mejorar los protocolos disponibles de evaluación de la población adulta mayor. Procedimiento: Se llevó a cabo un trabajo final de graduación en formato de práctica dirigida durante 858 horas tanto de forma presencial como a distancia, en el período de abril del 2017 a abril del 2018, participando de los procesos de evaluación neuropsicológica forense, elaboración de un protocolo de evaluación neuropsicológica forense y participación en procesos psicoeducativos sobre consumo de sustancias y violencia sexual. Resultados: En total se atendieron 40 personas hombres, entre 58 y 85 años de edad. Con variables sociodemográficas y de salud como una baja escolaridad (45%), con antecedentes de trauma craneoencefálico (67%) y en su mayoría cometieron abuso sexual (55%). Se elaboró un protocolo de evaluación neuropsicológica que incluye un módulo de entrevista y observación, evaluación del estado de ánimo y evaluación del funcionamiento cognitivo.

Abstract Introduction: Population ageing has become a priority between the attention and care systems but still deals with myths and discrimination, being the older adults incarcerated in the prison system a population with a greater risk of exclusion and that have neuropsychological characteristics that need attention. Therefore, a first approach was carried out in Costa Rica in the Institutional Adult Care Center from the forensic neuropsychology, to improve the available protocols for the evaluation of the older adult population. Method: A final graduation work was carried out in a guided practice format for 858 hours both in person and remotely, in the period from April 2017 to April 2018, participating in the processes of forensic neuropsychological evaluation, preparation of a protocol of forensic neuropsychological evaluation and participation in psychoeducational processes on substance use and sexual violence. Results: In total 40 male people, between 58 and 85 years of age, were attended. With sociodemographic and health variables such as low schooling (45%), with a history of cranioencephalic trauma (67%) and most of them committed sexual abuse (55%). A neuropsychological evaluation protocol was elaborated that includes an interview and observation module, evaluation of mood and evaluation of cognitive functioning module.

Comparative genomic analysis reveals novel facts about Leptospirillum spp. cytochromes.

Chemolithoautotrophic acidophilic bacteria, which belong to the genus Leptospirillum, can only grow with Fe(II) as electron donor and oxygen as an electron acceptor. Members of this genus play an important role in bioleaching sulfide ores. We used nearly complete genome sequences of Leptospirillum ferrooxidans (group I), Leptospirillum rubarum, Leptospirillum '5-way CG' (group II) and Leptospirillum ferrodiazotrophum (group III) to identify cytochromes that are likely involved in electron transfer chain(s). The results show the presence of genes encoding a number of c-type cytochromes (18-20 genes were identified in each species), as well as bd and cbb3 oxidases. Genes encoding cbb3 oxidase are clustered, with predicted genes involved in cbb3 maturation proteins. Duplication of cbb3 encoding genes (ccoNO) was detected in all four genomes. Interestingly, these micro-organisms also contain genes that potentially encode bc1 and b6f-like complexes organized into two putative operon structures. To date, the Leptospirillum genus includes the only organisms reported to have genes coding for two different bc complexes. This study provides detailed insights into the components of electron transfer chains of Leptospirillum spp., revealing their conservation among leptospirilla groups and suggesting that there may be a single common pathway for electron transport between Fe(II) and oxygen.

The effect of partial reinforcement on instrumental successive negative contrast in inbred Roman High- (RHA-I) and Low- (RLA-I) Avoidance rats.

Frustration is an emotional response that can be induced by the sudden devaluation of a reinforcer in the presence of greater reinforcement expectancies (e.g. instrumental successive negative contrast, iSNC). This emotional response seems to be similar to anxiety and can be attenuated by previous experiences of reward loss (e.g. partial reinforcement, PR, as opposed to continuous reinforcement, CR). In this study we used iSNC and PR procedures in order to compare the performance of two strains of rats psychogenetically selected on the basis of their emotional reactivity: the inbred Roman High- (RHA-I, low anxiety) and Low- (RLA-I, high anxiety) Avoidance rats. Animals were exposed to a straight alley, where they were changed from 12 pellets in the preshift phase (presented in 100% of trials-CR vs. 50% of trials-PR) to 2 pellets in the postshift phase, or exposed to 2 pellets throughout the training. The results indicated that the iSNC only appeared in RLA-I rats exposed to CR, as opposed to RLA-I animals exposed to PR and to RHA-I rats exposed to PR or CR. These data seem to support the implication of emotional responses in both iSNC and PR situations, and indicate that the behavioral reactivity to reward loss experiences is modulated by genetic variables.

[Bacteriological techniques for the design and identification of Mycobacterium tuberculosis]. / Tecnicas bacteriológicas para el diagnóstico e identificación de Mycobacterium tuberculosis.

This review summarizes the classic bacteriologic techniques used to diagnose M. tuberculosis and others mycobacterial infection. This methodology involves special methods such as staining, recovery in culture media and identification by phenotypic and biochemical characteristics. New methods for rapid diagnosis are been developed and the laboratories should be alert in order to incorporated them in their routine.

Reacciones sistémicas al medio de contraste intravascular / Intravascular contrast media: adverse drug reaction

Cada dia nuestro papel como anestesiólogo por fuera de la sala de operaciones es mayor. Uno de los sitios donde se hace más frecuente nuestra presencia en el radiodiagnostico, debido a la gran cantidad de procedimientos realizados con medio de contraste. En este articulo realizamos una revision muy detallada de la incidencia, prevalencia, etiologia, factores de riesgo y establecemos un protocolo de drogas utilizadas para la prevención de reacciones alergicas a medios de contraste y tratamiento en caso de ocurrir una de ellas

GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms.

BACKGROUND: Frequent attendance in general practice increases workload and affects doctor-patient relationships. It is a complex phenomenon, but patients' psychological problems appear to be important. AIM: To assess whether frequent attendance is more likely to be associated with depressive symptoms than with physical health problems. METHOD: The study was carried out in two general practices: one in Liverpool and one in Granada. Subjects comprised 127 frequent attenders (FAs) plus 175 matched controls, stratified by age and sex. Measures included demographic factors, Beck Depression Inventory (BDI), self-reported health, and current health problems classified by ICHPPC-2 criteria. RESULTS: Seventy-five (59%) FAs had a BDI score > or = 13, compared with 9 (5%) controls (odds ratio [OR] = 26.6, 95% confidence interval [CI] = 12.4 to 56.8, P < 0.001). A total of 136 (78%) controls reported their health to be good or excellent, compared with 40 (31%) FAs (OR = 7.6, 95% CI = 4.5 to 12.7, P < 0.001). Respiratory problems were present in 50 (39%) FAs and 47 (27%) controls (chi 2 = 6.992, P < 0.03). Depression rates were similar in Liverpool and Granada, although Liverpool subjects were less likely to report good health. On logistic regression, BDI status was the major predictor of frequent attendance (OR = 17.18, 95% CI = 7.54 to 39.01). Self-reported ill health (OR = 2.67, 95% CI = 1.40 to 5.10) and respiratory problems (OR = 2.20, 95% CI = 1.11 to 4.37) were also associated with frequent attendance. CONCLUSION: Depressive symptoms were the major predictor of frequent attendance in this study. Clinical and research activity should therefore concentrate on the identification and management of psychological problems among FAs in general practice.

Spontaneous changes in ventricular tachycardia cycle length and their relation to earliest sites of epicardial activation in a canine model.

BACKGROUND: The purpose of this study was to examine the spontaneous changes in cycle length during episodes of sustained monomorphic (MVT) and polymorphic (PVT) ventricular tachycardias and to relate these changes with the earliest epicardial activation site of the beat. METHODS: Isochronal activation maps were obtained from 127 unipolar electrograms recorded from the surface of both ventricles with a sock electrode array in 24 open chest anesthetized dogs. After atrioventricular block, the left anterior descending coronary artery was occluded for 60 min under ventricular pacing (140/min), followed by reperfusion. In 7 dogs the left stellate ganglion was stimulated 5 min after reperfusion. RESULTS: In 7 MVTs (reperfusion) and 4 PVTs (sympathetic stimulation), cycle length changes showed an initial acceleration, reaching a minimum cycle length and then decelerating before termination. Isochronal maps showed radial spread from earliest activation, without conduction block. Cycle length (481 +/- 80 msec) in MVT had beat to beat variations of 15 +/- 17 msec corresponding to small shifts in sites of the earliest activation, clustered along the border of the ischemic myocardium. In PVTs the cycle length (352 +/- 90 msec, p < 0.01) had a variability of 62 +/- 23 msec, corresponding to wide changes in the sites of earliest activation in right and left ventricles. Linear regression analysis showed a strong and significant correlation between cycle length variability and the number of electrodes with the earliest activation (r = 0.77, p < 0.0001). CONCLUSION: In these models of monomorphic and polymorphic ventricular tachycardias, cycle length variability showed a significant correlation with the number of electrodes with the earliest activation. MVTs showed concentrated origins with regular cycle length, whereas PVTs showed dispersed origins with irregular cycle length. These results suggest that the earliest epicardial activation site of the beat could be a factor in determining the dynamics in the cycle length.

[Transesophageal echocardiography in the study of intracardiac thrombosis, tumors and vegetations]. / Ecocardiografia transesofagica en el estudio de trombos, tumores y vegetaciones intracardiacos.

Of 200 consecutive patients, studied with transesophageal echocardiography the findings were analyzed with respect to the presence of thrombi, tumors or vegetations. Thrombus formation was detected in 18 patients; their location and associated pathology are described. Tumors were present in 9 cases and in 10 patients endocarditis in native or prosthetic valves. The information obtained by transesophageal echocardiography was compared with transthoracic echocardiographic data. Transoesophageal echocardiography was demonstrated to be more sensitive, especially in the detection of intracavitary masses in the posterior structures of the heart.