Medical History and Preoperative Coagulation Profile as Predictors of Outcomes in Elective Spinal Surgery: A Meta-Analysis.

BACKGROUND: In patients with unremarkable medical history, comprehensive preoperative hemostasis screening in elective neurosurgery remains debated. Comprehensive medical history has shown to be noninferior to coagulation profile to evaluate surgical outcomes. This study aims to evaluate the predictiveness of preoperative coagulation screening and medical history for surgical outcomes. METHODS: Databases were searched until April 2023 for observational cohort studies that reported preoperative hemostasis screening and clinical history prior to elective neurosurgical procedures. Outcomes of interest included postoperative transfusion, mortality, and complications. Pooled relative risk ratios (RRs) were analyzed using random-effects models. RESULTS: Out of 604 studies, 3 cohort studies met our inclusion criteria, adding a patient population of 83,076. Prolonged partial thromboplastin time (PTT; RR=1.42, 95% confidence interval [CI] =1.14, 1.77, P=0.002), elevated international normalized ratio (INR; RR=2.01, 95% CI=1.14, 3.55, P=0.02), low platelet count (RR=1.58, 95% CI=1.34, 1.86, P<0.00001), and positive bleeding history (RR=2.14, 95% CI=1.16, 3.93, P=0.01) were associated with postoperative transfusion risk. High PTT (RR=2.42, 95% CI=1.24, 4.73, P=0.010), High INR (RR=8.15, 95% CI=5.97, 11.13; P<0.00001), low platelet count (RR=4.89, 95% CI=3.73, 6.41, P<0.00001), and bleeding history (RR=7.59, 95% CI=5.84, 9.86, P<0.00001) were predictive of mortality. Prolonged PTT (RR=1.53, 95% CI=1.25, 1.86, P=<0.0001), a high INR (RR=3.41, 95% CI=2.63, 4.42, P=< 0.00001), low platelets (RR=1.63, 95% CI=1.40, 1.90, P=<0.00001), and medical history (RR=2.15, 95% CI=1.71, 2.71, P=<0.00001) were predictive of complications. CONCLUSIONS: Medical history was a noninferior predictor to coagulation profile for postoperative transfusion, mortality, and complications. However, our findings are mostly representative of elective spinal procedures. Cost-effective alternatives should be explored to promote affordable patient care in patients with unremarkable history.

Primary Cilia as a Tumor Marker in Pituitary Neuroendocrine Tumors.

Pituitary neuroendocrine tumors (PitNETs) account for approximately 15% of all intracranial neoplasms. Although they usually appear to be benign, some tumors display worse behavior, displaying rapid growth, invasion, refractoriness to treatment, and recurrence. Increasing evidence supports the role of primary cilia (PC) in regulating cancer development. Here, we showed that PC are significantly increased in PitNETs and are associated with increased tumor invasion and recurrence. Serial electron micrographs of PITNETs demonstrated different ciliation phenotypes (dot-like versus normal-like cilia) that represented PC at different stages of ciliogenesis. Molecular findings demonstrated that 123 ciliary-associated genes (eg, doublecortin domain containing protein 2, Sintaxin-3, and centriolar coiled-coil protein 110) were dysregulated in PitNETs, representing the upregulation of markers at different stages of intracellular ciliogenesis. Our results demonstrate, for the first time, that ciliogenesis is increased in PitNETs, suggesting that this process might be used as a potential target for therapy in the future.

[Review of a pioneer book on epidemics by Risueño de Amador (1829)]. / Revisión de un libro pionero sobre epidemias de Risueño de Amador (1829).

This article reviews and comments on the epidemiological book written by the Spanish physician Benigno Risueño de Amador (1802-1849), initially published in French (1829), and its subsequent translation into Spanish (1831). This retrospective documentary case study of a scientific-medical manual reviews the contents of the book, highlighting its most important aspects. This almost 200-year-old book can be considered a valuable, early contribution to epidemiology, and a sign of the great concern in early 19th Europe about the subject of epidemics. It represents a valuable contribution that shows the enormous efforts made to advance in this medical discipline towards a more scientific position at an incipient microbial time.

En este artículo se revisa y comenta el libro de epidemiología escrito por el médico español Benigno Risueño de Amador (1802-1849), publicado inicialmente en francés (1829) y posteriormente traducido al español (1831). Este estudio documental retrospectivo de un manual científico-médico glosa el contenido del libro, destacando sus aspectos más importantes. El libro de casi doscientos años de antigüedad puede considerarse una valiosa y temprana contribución a la epidemiología, así como una muestra de la gran preocupación existente en la Europa de principios del siglo XIX por el tema de las epidemias. Representa además una valiosa contribución española, que muestra los esfuerzos realizados para avanzar en esta disciplina médica hacia una posición más científica en una época incipientemente microbiana.

Revisión de un libro pionero sobre epidemias de Risueño de Amador (1829) / Review of a pioneer book on epidemics by Risueño de Amador (1829)

En este artículo se revisa y comenta el libro de epidemiología escrito por el médico español Benigno Risueño de Amador (1802-1849), publicado inicialmente en francés (1829) y posteriormente traducido al español (1831). Este estudio documental retrospectivo de un manual científico-médico glosa el contenido del libro, destacando sus aspectos más importantes. El libro de casi doscientos años de antigüedad puede considerarse una valiosa y temprana contribución a la epidemio-logía, así como una muestra de la gran preocupación existente en la Europa de principios del siglo XIX por el tema de las epidemias. Representa además una valiosa contribución española, que muestra los esfuerzos realizados para avanzar en esta disciplina médica hacia una posición más científica en una época incipientemente microbiana.(AU)

This article reviews and comments on the epidemiological book written by the Spanish physician Benigno Risueño de Amador (1802-1849), initially published in French (1829), and its subsequent translation into Spanish (1831). This retrospective documentary case study of a scientific-medical manual reviews the contents of the book, highlighting its most important aspects. This almost 200-year-old book can be considered a valuable, early contribution to epidemiology, and a sign of the great concern in early 19th Europe about the subject of epidemics. It represents a valuable contribution that shows the enormous efforts made to advance in this medical discipline towards a more scientific position at an incipient microbial time.(AU)

Coronary Artery Disease in Women: Getting to Know Gender Related Disparities

Abstract Coronary artery disease (CAD) and ischemic heart disease (IHD) are often indistinctly used terms. Both combined have generated, over the past years, concerns about sex disparities in their presentation. From an epidemiological perspective, females have several disadvantages regarding the prevention, diagnosis, and treatment of CAD. Most of the general cardiovascular risk factors affect women more frequently, or with a higher morbidity and mortality association. Besides, atypical manifestations of the disease and uncommon forms of CAD represent a diagnostic challenge for clinicians. Even if current treatments for CAD have no apparent sex bias, women representation in clinical trials and treatment patterns analyzed in clinical practice refuse this statement. Several disparities are caused by inevitable sex-particularities, but many of them are more social, cultural, and dogmatic beliefs that have to be addressed and overhaul.

Documentos españoles sobre enseñanza de la medicina en el siglo XIX / Spanish documents about teaching of Medicine in the 19th century

Introducción: Este estudio indaga la producción de documentos españoles publicados a lo largo de todo el siglo XIX, centrados en consideraciones pedagógicas sobre la enseñanza y el aprendizaje de la medicina y sus especialidades, y que no son libros de texto o manuales específicos de medicina.Materiales y métodos.Estudio diacrónico retrospectivo de análisis documental que usa una muestra intencional de títulos de documentos relativos a la enseñanza-aprendizaje de la medicina en España, recuperados tras una búsqueda en la base CISNE-UCM con la secuencia de palabras clave: Enseñanza y Medicina. Desde: 1800 a 1900.Resultados.Se recuperaron 33 documentos. La relación de títulos expuesta, como ordenanzas, memorias, lecciones inaugurales, ensayos, propuestas de reforma, directrices, reflexiones y orientaciones, es abundante. Algunos títulos se muestran como de una singular relevancia; por ejemplo, el discurso de Sánchez Toca, los ensayos de Salvá y Campillo o las minuciosas instrucciones generales y numeradas del libro de Guerra, los cuales pueden considerarse cualificados aportes pioneros de una pedagogía médica española.Conclusiones.Todos estos documentos tienen un común denominador: la mejora de la enseñanza de la medicina. La producción de documentos, tanto en calidad como en cantidad, disiparía la creencia de la baja preocupación española por la enseñanza de la medicina con criterios modernos. (AU)

Introduction: This study inquiries the production of Spanish documents published throughout the 19th century, focused on pedagogical considerations on the teaching and learning of Medicine and its specialties, and which are not textbooks or manuals specific of Medicine.Materials and methods.Retrospective diachronic study of documentary analysis using a purposive sample of titles of documents related to the teaching-learning of Medicine in Spain, retrieved after a search in the CISNE-UCM database with the keyword sequence: Teaching and Medicine. From: 1800 to 1900.Results.Thirty-three documents were retrieved. The list of titles exposed as ordinances, memoirs, inaugural lectures, essays, reform proposals, guidelines, reflections and orientations is ample. Some titles are revealed as being of singular relevance; for example: the Sánchez Toca's speech, the essays of Salvá and Campillo, the meticulous general or numbered instructions of Guerra's book, which can be considered as qualified pioneering contributions of a Spanish medical pedagogy.Conclusions.All these documents have a common denominator: the improvement of the teaching of Medicine. The production of documents both in quality and quantity would dispel the belief of the low Spanish concern for medical education with modern criteria. (AU)

Effect of Preoperative Infusion of Levosimendan on Biomarkers of Myocardial Injury and Haemodynamics After Paediatric Cardiac Surgery: A Randomised Controlled Trial.

OBJECTIVE: The aim was to test the hypothesis that preoperative infusion of levosimendan would decrease patients' cardiac biomarker profiles during the immediate postoperative stage (troponin I and B-type natriuretic peptide levels) more efficiently than placebo after cardiopulmonary bypass. METHODS: In a randomised, placebo-controlled, double-blinded study, 30 paediatric patients were scheduled for congenital heart disease surgery. 15 patients (50%) received prophylactic levosimendan and 15 patients (50%) received placebo from 12 h before cardiopulmonary bypass to 24 h after surgery. RESULTS: Troponin I levels were higher in the placebo group at 0, 12, and 24 h after cardiopulmonary bypass, although the mean differences between the study groups and the 95% confidence intervals (CIs) for troponin I levels did not present statistically significant differences at any of the three time points considered (mean differences [95% CIs] - 3.32 pg/ml [- 19.34 to 12.70], - 2.42 pg/ml [- 19.78 to 13.95], and - 79.94 pg/ml [- 266.99 to 16.39] at 0, 12, and 24 h, respectively). A similar lack of statistically significant difference was observed for B-type natriuretic peptide (mean differences [95% CIs] 36.86 pg/dl [- 134.16 to 225.64], - 350.79 pg/dl [- 1459.67 to 557.45], and - 310.35 pg/dl [- 1505.76 to 509.82]). Lactic acid levels were significantly lower with levosimendan; the mean differences between the study groups and the 95% CIs for lactate levels present statistically significant differences at 0 h (- 1.52 mmol/l [- 3.19 to - 0.25]) and 12 h (- 1.20 mmol/l [- 2.53 to - 0.10]) after cardiopulmonary bypass. Oxygen delivery (DO2) was significantly higher at 12 h and 24 h after surgery (mean difference [95% CI] 627.70 ml/min/m2 [122.34-1162.67] and 832.35 ml/min/m2 [58.15 to 1651.38], respectively). CONCLUSIONS: Levosimendan does not significantly improve patients' postoperative troponin I and B-type natriuretic peptide profiles during the immediate postoperative stage in comparison with placebo, although both were numerically higher with placebo. Levosimendan, however, significantly reduced lactic acid levels and improved patients' DO2 profiles. These results highlight the importance of this new drug and its possible benefit with regard to myocardial injury; however, evaluation in larger, adequately powered trials is needed to determine the efficacy of levosimendan. Trial registry number: EudraCT 2012-005310-19.

Un precursor de la pedagogía médica en España: Francesc Salvà I Campillo / A pioneer of medical education in Spain: Francesc Salvà I Campillo

Buscando antecedentes y pioneros de la pedagogía médica en España, se recupera la figura y obra del médico y docente catalán Francesc Salvà I Campillo (1751-1828) mediante la revisión historiográfica de libros sobre enseñanza de la medicina, que no libros de texto ni monografías especializadas, escritos por Salvà, un personaje polifacético e ilustrado. Se muestran las concepciones pedagógicas del autor sobre la 'enseñanza del arte de curar' basada en el estudio de casos. Sus escritos a modo de ensayos muestran una gran preocupación por la mejora de la enseñanza de la medicina en Cataluña y en el resto de España. Además, son de una lectura amena y atañen a aspectos hoy en día todavía de gran actualidad: la financiación de los estudios médicos, el enfoque práctico de la enseñanza y la importancia de la higiene para la mejora de las condiciones de vida de un proletariado industrial entonces emergente en Cataluña. Francesc Salvà I Campillo bien puede considerarse el precursor de la pedagogía médica española con una indudable influencia posterior a lo largo del siglo XIX

Looking for background and pioneers of medical education in Spain, the figure and work of the Catalonian doctor and teacher Francesc Salvà I Campillo (1751-1828) is recovered, through a historiographical review of books on teaching of medicine, but no textbooks nor specialized monographs, written by Salvà, a multifaceted and enlightened character. The author's pedagogical conceptions about the 'teaching of the art of healing' based on case studies are shown. His writings as essays show great concern for the improvement of the teaching of medicine in Catalonia and in the rest of Spain. In addition, they are of a pleasant reading on aspects that still concern high-date issues today: the financing of medical studies, the practical approach to teaching and the importance of hygiene for improving the living conditions of a proletariat from the industrial sector then emerging in Catalonia. Francesc Salvà I Campillo may well be considered the forerunner of Spanish medical education with an undoubted subsequent influence throughout the 19th century

Tesis doctorales de Medicina defendidas por mujeres pioneras en España (1882-1954) / Doctoral theses in Medicine by pioneer women in Spain (1882-1954)

FUNDAMENTO Y OBJETIVO: La presencia de mujeres pioneras en estudios superiores de Medicina en España cuenta con notables realizaciones. Este estudio indaga tesis doctorales en Medicina defendidas por mujeres en España desde 1882 a 1954 (el 1% de la producción total para ese periodo) e indexadas en las bases Cisne de la Universidad Complutense de Madrid. MATERIAL Y MÉTODO: Se recuperan y revisan 50 tesis doctorales. Se realiza un estudio longitudinal retrospectivo de análisis documental de tesis doctorales identificadas por año de defensa, título de cada tesis, nombre de la doctora, especialidad médica adscribible y palabras clave. RESULTADOS: El número de tesis de mujeres autoras se incrementa linealmente a lo largo del tiempo. Las especialidades médicas más comunes de tales tesis son: Ginecología y Obstetricia, Farmacología, Hematología, Pediatría y Endocrinología. También se realiza un conteo de frecuencias de los descriptores, en el cual destacan los términos: farmacología/terapia, educación, patogenia, enfermedad y niños. DISCUSIÓN Y CONCLUSIONES: La Medicina española dispone de 50 tesis doctorales pioneras defendidas por mujeres entre 1882 y 1954, aunque estas representan solo el 1% de la producción total de tesis doctorales en Medicina para ese periodo. Tan exiguo porcentaje alerta de un sesgo por techo de cristal que podría estar gravitando aún sobre las mujeres médicas. Una recomendación final se emite alentando a mejorar la situación de la mujer investigadora en Medicina

BACKGROUND AND OBJECTIVE: The presence of pioneer women in Spanish Medical Education has a notable impact. The objective of this study is to investigate doctoral theses in Medicine written by women in Spain between 1882 and 1954 and indexed in the Cisne library catalogue of Madrid Complutense University. These theses account for 1% of the total output for the period. MATERIAL AND METHOD: This retrospective longitudinal document analysis study examines doctoral theses identified by year of submission, title, author's name, ascribable medical speciality, and keywords. A total of 50 doctoral theses were identified and reviewed. RESULTS: The number of theses by female authors increased linearly over time. The most common medical specialities studied by female candidates were gynaecology and obstetrics, pharmacology, haematology, paediatrics, and endocrinology. The frequency of study descriptors was also calculated, and the following key terms detected: pharmacology/therapy, education, pathogenesis, disease, and children. DISCUSSION AND CONCLUSIONS: A total of 50 doctoral theses in medicine were written by pioneer female candidates in Spain between 1882 and 1954, accounting for just 1% of total output during this period. This tiny percentage indicates potential bias due to a glass ceiling that may continue to be a barrier to female doctors today. More still needs to be done to improve conditions for female medical researchers

Hispanic women in doctoral medical education in 19th century / Mujeres hispanas en la educación médica doctoral del siglo XIX

BACKGROUND: Women's access to education, and more specifically, to medical studies has been a long and painful conquest for equality. In the 19th century, the number of women who actually went to Hispanic universities was small. Method: This is a descriptive historical and documentary study that reviews six doctoral dissertations retrieved from two databases, the Catálogo Completo and Tesis UCM, from the Complutense University of Madrid. RESULTS: This study recovers and describes six pioneer doctoral theses defended in nineteenth century by Hispanic women, and it attempts to highlight the early presence of Hispanic women doctors in the field of medical doctoral education as professionals of the highest academic excellence. Specifically, it comments on five medical doctorates and one medical-pharmaceutical doctorate written by three Spanish women, as well as one Colombian, one Argentinean, and one Cuban woman. CONCLUSIONS: A key conclusion is that Hispanic women have produced six pioneering dissertations of singular importance with a multidisciplinary medical scope covering the topics, such as women education, hygiene, ophthalmology, gynecology, and pharmacology

ANTECEDENTES: El acceso de las mujeres a la educación y más específicamente a los estudios médicos ha supuesto una conquista larga y penosa por la igualdad. En el siglo XIX el número de mujeres que fueron a las universidades hispanas fue pequeño. MÉTODO: Se trata de un estudio descriptivo histórico y documental que revisa seis tesis doctorales pioneras recuperadas de dos bases de datos, el Catálogo Completo y Tesis UCM, de la Universidad Complutense de Madrid. RESULTADOS: Este estudio recupera y describe seis tesis doctorales defendidas en el siglo XIX por mujeres hispanas, y trata de destacar la temprana presencia de las mujeres en el campo de la educación médica doctoral y como profesionales de la más alta excelencia académica. Concretamente, comenta las tesis de cinco doctoras médicas y una doctora médico-farmacéutica escritas por tres mujeres españolas, una colombiana, una argentina y una cubana. CONCLUSIONES: Como conclusión clave se muestra como, en el siglo XIX, seis mujeres hispanas produjeron otras tantas tesis pioneras, de singular relevancia, y con un alcance médico multidisciplinario que cubre temas tales como: la educación de las mujeres, la higiene, la oftalmología, la obstetricia y la farmacología

Bienestar psicológico, optimismo y resiliencia en mujeres con cáncer de mama / Psychological well-being, optimism and resilience in women with breast cancer

Objetivo: Evaluar la relación existente entre Bienestar Psicológico Percibido, Optimismo y Resiliencia en mujeres supervivientes de cáncer de mama. Método: La muestra la conformaron 30 mujeres diagnosticadas de cáncer de mama que se encontraban en fase de tratamiento adyuvante en las Unidades de Oncología del Hospital General de Jerez de la Frontera y del Hospital Universitario Puerta del Mar (Cádiz). La media de edad fue de 47,47 años (DT = 6,356) y la media de meses desde el diagnóstico de la enfermedad fue 9,93 (DT = 8,541). Se administraron la Escala de Bienestar Psicológico Percibido de Ryff (1989), el Life Orientation Test Revised (LOT-R) de Scheier, Carver y Bridges (1994) y la Escala de Resiliencia de Wagnild y Young (1993) para evaluar el Bienestar Psicológico, el Optimismo disposicional y la Resiliencia respectivamente. Resultados: Los análisis descriptivos muestran que las mujeres diagnosticadas de cáncer de mama presentan niveles de Bienestar Psicológico, Optimismo disposicional y Resiliencia superiores a los valores medios aportados por las escalas. Por otro lado, los análisis de regresión revelaron que sólo algunas de las dimensiones de Resiliencia permitían explicar y predecir algunas dimensiones de Bienestar psicológico, no así el Optimismo disposicional. Conclusiones: Los resultados parecen confirmar la idea de que si se trabaja la capacidad de las mujeres con cáncer de mama de moderar el afecto negativo generado por el propio diagnóstico y las consecuencias derivadas de su tratamiento, así como su capacidad de adaptación a la nueva situación, podremos contribuir al incremento de su Bienestar Psicológico

Objective: To evaluate the relationship between Perceived Psychological well-being, Optimism and Resilience in women survivors of breast cancer. Method: The sample was composed of 30 women diagnosed with breast cancer who were undergoing adjuvant treatment in Oncology Units General Hospital of Jerez de la Frontera and the University Hospital Puerta del Mar (Cadiz). The average age was 47.47 years (SD = 6,356) and the average of months from diagnosis of the disease was 9.93 (SD = 8,541). Scale of Psychological Well-being administered Perceived Ryff (1989), the Life Orientation Test Revised (LOT-R) Scheier, Carver and Bridges (1994) and the Scale of Resilience Wagnild and Young (1993) to assess psychological wellbeing the dispositional optimism and resilience respectively Results: Descriptive analyzes show that women diagnosed with breast cancer have levels of psychological well-being, dispositional optimism and higher than the average values provided by Resilience scales. On the other hand, regression analyses revealed that only some of the dimensions of resilience allowed to explain and predict some dimensions of psychological wellbeing, not dispositional optimism. Conclusions: The results seem to confirm the idea that if the capacity of women with breast moderate negative affect generated by the diagnosis itself and the consequences of their cancer treatment works and to promote their adaptation to the new situation we can contribute to increasing psychological wellbeing

A pioneering on medical education: The seminal text of J. P. Frank's De medicis peregrinationibus - Medical travels (1792) / Un pionero de la educación médica: el texto fundamental De medicis peregrinationibus (Viajes médicos), de J. P. Frank (1792)

BACKGROUND: Medical travel is a general term for all journeys made by a health professional, and are common practice for education and training as a significant globalised topic in modern medical education, and their relevance dates back far into history. METHODS: A historical-documental method is used in this study. It re-examines and discusses critically the J. P. Frank text De medicis peregrinationibus (medical travel) written in 1792. Findings. This paper enlightens on the meaning and usefulness of medical travels towards the end of the 18th century. A critical review of the text is carried out in order to compare medical travel and medical education towards the end of the 18th century with the same travel and education today. The authors discuss a number of relevant points that Frank makes regarding travelling physicians, the meaning and usefulness of medical travels, as well as about a proposed curriculum for travelling physicians that could still be followed today. CONCLUSIONS: As a general conclusion, Frank's paper could be considered a seminal work on medical travel for educational purposes. His observations are still relevant today, reflected in students travelling abroad as part of mobility programmes in medical education

ANTECEDENTES: Los viajes médicos, como término general para todo viaje realizado por un profesional de la salud, son una práctica habitual para su educación y capacitación, que conforma además un significativo tópico globalizado de la educación médica moderna, aunque su relevancia se remonte en la historia. MÉTODO: Esta investigación utiliza un método histórico-documental. Revisa y analiza críticamente el texto De medicis peregrinationibus (Viajes médicos) escrito por J. P. Frank en 1792. Hallazgos: Este artículo explica el significado y la utilidad para el aprendizaje de los viajes médicos hacia finales del siglo xviii. Se lleva a cabo una revisión crítica del texto, tratando de comparar viajes médicos e instrucción médica hacia finales del sigloxviii con los mismos viajes y educación hoy en día. Se discuten una serie de puntos relevantes que Frank realiza con respecto a los viajes médicos, su significado y la utilidad de estos, comentando una propuesta curricular para los médicos viajeros que bien podrían seguirse aún hoy. CONCLUSIONES: Como conclusión general, el texto de Frank podría considerarse una obra fundamental sobre los viajes médicos con fines educativos. Sus observaciones son aún relevantes hoy en día, tal como se refleja en los estudios sobre estudiantes que viajan al extranjero en la actualidad como parte de programas de movilidad en su formación médica

Cardiovascular profile of defensive hostile women in a real stressful situation / Perfil cardiovascular de mujeres hostiles defensivas en una situación de estrés real

The main objective of this study was to analyze the impact of defensive hostility on cardiovascular response in a stressful situation. By measuring three of the most commonly used cardiovascular indexes (heart rate, systolic blood pressure and diastolic blood pressure) over three experimental phases (adaptation, task and recovery), the evolution of cardiovascular response was analyzed minute by minute throughout the entire experimental session, to check if the defensive hostility influences the cardiovascular function. Two scales were used: the Cook-Medley Composite Hostility Scale and the Marlowe-Crowne Social Desirability Scale. Based on the scores on these scales, there were formed four groups (high hostility and high defensiveness, high hostility and low defensiveness, low hostility and high defensiveness, and low hostility and low defensiveness). The stressful situation which was used in the task phase was a real academic examination (exam of the Psychology degree). The hypothesis was that cardiovascular response, activation and recovery, minute by minute, will be greater in hostile defensive women, with an intra-phase evolution profile characterized by maintenance or sensitization and slow recovery. Results show that defensive hostile individuals present the highest values in the physiological variables recorded, and less adaptive profile

El objetivo del presente estudio ha sido analizar el impacto de la hostilidad defensiva sobre la respuesta cardiovascular en una situación estresante. Mediante la medición de la frecuencia cardiaca, la presión sistólica y la presión diastólica, a través de las tres fases del experimento (adaptación, tarea y recuperación), hemos analizado la evolución de la respuesta cardiovascular minuto a minuto a lo largo de toda la sesión experimental, para comprobar si la hostilidad defensiva influye sobre la función cardiovascular. Se utilizaron dos escalas: la Escala Compuesta de Hostilidad del inventario de hostilidad de Cook-Medley y la escala de deseabilidad social de MarloweCrowne. Basándonos en las puntuaciones de estas escalas, se formaron cuatro grupos (alta hostilidad-alta defensividad, alta hostilidad-baja defensividad, baja hostilidad-alta defensividad, y baja hostilidad-baja defensividad). La situación de estrés utilizada en la tarea fue un examen real. La hipótesis propuesta fue que la respuesta cardiovascular, la activación y la recuperación, minuto a minuto, serían mayores en las mujeres hostiles defensivas, con un perfil de evolución caracterizado por el mantenimiento o la sensibilización y la recuperación lenta. Los resultados muestran que las personas hostiles defensivas presentan los valores más altos en las variables fisiológicas registradas, así como perfiles menos adaptativos

[Influence of age in short and long term prognostic of ischemic cardiogenic shock]. / Influencia de la edad en el pronóstico a corto y largo plazo del choque cardiogénico de origen isquémico.

OBJECTIVE: To compare the prognosis during hospitalization and maximum follow-up of 4 years in patients with myocardial infarction complicated with cardiogenic shock. METHOD: Prospective observational study practiced in a coronary Care Unit managed by cardiologists. We included patients with myocardial infarction complicated with cardiogenic shock who received early coronary revascularization. Patients were divided into two groups: older than 75 years (group A) and lower (group B), and we compared the evolution during hospitalization and maximum follow-up of 4 years. Primary end point was mortality rate in the maximum follow-up of 4years. Secondary end point was mortality rate during hospitalization. RESULTS: Ninety-seven patients were included, 45% Group A. Patients of Group B were mostly men (81% vs. 57%; P=.014), diabetics (48% vs. 21%; P=0.006), and smokers (39.6% vs. 5%). Mortality rate during hospitalization was higher in Group A (54.5%) vs. 30.2% in Group B (P=.022). Mortality rate during follow-up (primary variable) was 73% in Group A vs. 38% in Group B (P=.007). CONCLUSIONS: Myocardial infarction complicated with cardiogenic shock in elderly patients is an entity with high mortality during hospitalization and continues to worsen during long term follow-up.

Influencia de la edad en el pronóstico a corto y largo plazo del choque cardiogénico de origen isquémico / Influence of age in short and long term prognostic of ischemic cardiogenic shock

Objetivo: Comparar la evolución durante el ingreso y a largo plazo de pacientes con choque cardiogénico de origen isquémico. Método: Estudio observacional prospectivo unicéntrico llevado a cabo en la unidad coronaria de un hospital terciario manejada por cardiólogos. Se incluyen pacientes con choque cardiogénico de origen isquémico que recibieron revascularización coronaria precoz. Dividimos a los pacientes en 2 grupos: mayores de 75 anos (grupo A) y menores (grupo B), y comparamos la evolución durante el ingreso y en un seguimiento máximo de 4 años. El objetivo principal fue estimar la mortalidad a los 4 años. El objetivo secundario se definió como la mortalidad intrahospitalaria. Resultados: Incluimos a 97 pacientes, 44 del grupo A (45%). Los pacientes del grupo B eran con más frecuencia varones (81 vs. 57%, p = 0.014), diabéticos (49 vs. 21%, p: 0.006) y fumadores (39.6 vs. 4.5%, p < 0.05). La mortalidad hospitalaria fue superior en el grupo A (54.5 vs. 30.2%, p = 0.022). El objetivo principal ocurrió en 32 pacientes del grupo A frente a 20 del grupo B (73 vs. 38%, p = 0.007). Conclusión: El choque cardiogénico de origen isquémico en paciente mayores de 75 anos presenta una alta mortalidad durante la estancia hospitalaria y en el seguimiento a largo plazo.

Objective: To compare the prognosis during hospitalization and maximum follow-up of 4 years in patients with myocardial infarction complicated with cardiogenic shock. Method: Prospective observational study practiced in a coronary Care Unit managed by cardiologists. We included patients with myocardial infarction complicated with cardiogenic shock who received early coronary revascularization. Patients were divided into two groups: older than 75 years (group A) and lower (group B), and we compared the evolution during hospitalization and maximum follow-up of 4 years. Primary end point was mortality rate in the maximum follow-up of 4years. Secondary end point was mortality rate during hospitalization. Results: Ninety-seven patients were included, 45% Group A. Patients of Group B were mostly men (81% vs. 57%; P =.014), diabetics (48% vs. 21%; P = 0.006), and smokers (39.6% vs. 5%). Mortality rate during hospitalization was higher in Group A (54.5%) vs. 30.2% in Group B(P = .022). Mortality rate during follow-up (primary variable) was 73% in Group A vs. 38% in Group B (P =.007). Conclusions: Myocardial infarction complicated with cardiogenic shock in elderly patients is an entity with high mortality during hospitalization and continues to worsen during long term follow-up.

El efecto de memoria congruente con el estado afectivo reconocimiento diferencial de palabras de tristeza y alegría / The mood congruence memory effect: Differential recognition of sadness and joy words

Los estudios sobre el efecto de congruencia con el estado de ánimo suelen utilizar muestras clínicas de personas depresivas, utilizan programas de inducción de afecto introspectivos, y miden la memoria con tareas de recuerdo libre. Nosotros pretendemos comprobar esta hipótesis induciendo dos estados de ánimo contrapuestos en 100 participantes sin patología. El objetivo fue estudiar la influencia de los estados de ánimo en el reconocimiento de palabras congruentes con dichos estados de ánimo. Para inducir los estados afectivos, utilizamos la asociación de imágenes y música con la dimensión de tristeza y de alegría. Después aprendieron palabras relacionadas con ambos estados emocionales. Encontramos efectos de interacción entre el tipo de estado afectivo inducido y el reconocimiento de las palabras emocionales, tanto en latencias como en índices de discriminación A'. Sin embargo, encontramos diferencias en el reconocimiento dependiendo del tipo de estado de ánimo. El efecto de congruencia con el estado de ánimo se produce en el procesamiento de palabras de la categoría de tristeza, pero no en las palabras de la categoría de alegría. Éstas tienen latencias más rápidas e índices de discriminación más altos, al margen del estado inducido experimentalmente (AU)

Studies on the mood congruence effect commonly used clinical samples of depressed people use affect induction programs introspective, and measure the memory with free recall tasks. We intend to verify this hypothesis induces two conflicting moods in 100 participants without pathology. The aim was to study the influence of mood on the recognition of words congruent with those moods. To induce affective states, we use the association of images and music with the dimension of sadness and joy. After they learned words related to the two emotional states. We found interaction effects between type of induced emotional state and recognition of emotional words in both latencies as indices of discrimination A '. However, we found differences in the recognition depending on the mood. The mood congruence effect occurs in the processing of words in the category of sadness, but not in the words of the category of joy. These latencies are faster and higher rates of discrimination, regardless of the experimentally induced state (AU)

Dolor torácico y ascenso del ST en cara anterior / Chest pain and ST elevation in anterior leads

Presentamos el caso de una mujer de 79 años que ingresa en el servicio de Cardiología tras acudir a Urgencias con síntomas sugerentes de un síndrome coronario agudo, llegando a un diagnóstico cada vez más frecuente y quizá infradiagnosticado años atrás. El Síndrome de Takotsubo es una entidad clínica predominante en mujeres postmenopáusicas y se presenta típicamente tras un estrés físico o psíquico intenso. El cuadro clínico remeda el de un síndrome coronario agudo, sin embargo es característica la ausencia de lesiones angiográficas coronarias y un patrón ecocardiográfico de "balonización" del ventrículo izquierdo por hipercontractilidad de los segmentos basales y discinesia apical. Estas alteraciones suelen recuperarse completamente en el transcurso de unas semanas. Exponemos además una pequeña revisión sobre el estado actual del diagnóstico y tratamiento (AU)

We report a case of a 79 year old woman admitted to our Cardiology department for symptoms suggestive of acute coronary syndrome, eventually reaching an increasingly common diagnosis of a syndrome that was perhaps under-diagnosed in previous years. Takotsubo syndrome is a clinical entity predominantly occurring in postmenopausal women typically after severe physical or psychological stress. The symptoms mimic an acute coronary syndrome, however the absence of coronary angiographic lesions and an echocardiographic pattern of "apical ballooning" in the left ventricle because of hyperkinesis of the basal segments and apical dyskinesia are characteristic of this syndrome. These symptoms are usually fully resolved within a few weeks. We also present a brief review of the current state of its diagnosis and treatment (AU)

Impact of defensive hostility in cardiovascular disease.

Among the psychosocial factors that may influence the development, maintenance, and progression of cardiovascular disease, defensive hostility as a possible risk factor has received substantial empirical support in recent years. The aim of our study was to analyze the relationship between defensive hostility and cardiovascular response to stress situations, as a better predictor of cardiovascular functioning than hostility alone. The sample was composed of 130 female university students. The Cook-Medley Hostility Inventory (Ho) and the Spanish version (CRP) of the Marlowe-Crowne Social Desirability Scale (MC) were used to measure defensive hostility. We used the registration system MP150 (Biopac) to measure the physiological variables throughout the 3 experimental phases (adaptation, task, and recovery). The stress task was a real exam. We expected cardiovascular responses, heart rate, and systolic and diastolic blood pressure to be higher in subjects with high hostility and high defensiveness in all 3 phases. The results reflect that individuals with high hostility and high defensiveness present the highest values in the physiological variables, thus supporting the hypothesis that defensive hostility shows the greatest predictive power in relation to cardiovascular functioning in stressful situations.