Clinical effectiveness of a cardiology outpatient management plan to reduce inefficiency in consultations.

Objectives: Longer delays in carrying out complementary tests in cardiology services have resulted in patients arriving for consultation without these tests being performed (inefficient consultations). To ameliorate this situation, a management-based intervention was designed, optimizing the available resources and modifying the appointment system. Therefore, our objective was to determine the effectiveness of this intervention to reduce the number of inefficient consultations and improve the clinical care process.Methods: A non-randomized experimental study comparing two periods (pre- and post-intervention) was designed, analyzing a total of 473 outpatients attending cardiology consultations in a Spanish region in February 2014 (pre-intervention) and 441 patients attending cardiology consultations in November 2014 (post-intervention). The outcome of management measures aimed at optimizing coordination in outpatient care to reduce inefficient consultations was analyzed. After the visit, treatment modifications, requests for new examinations or tests, outpatient discharges, and new diagnoses were evaluated.Results: In the pre-intervention period, 37.2% of the patients had not had the tests performed, while in the post-intervention period, this figure dropped to 10.7% (p < 0.001). When the patients had all the tests completed, there was an increase in the number of new examinations (p < 0.001), outpatient discharges (p < 0.001) and new diagnoses (p = 0.004). Treatment modifications were not significant (p = 0.223).Conclusions: The intervention proved effective, clinically relevant, and statistically significant in reducing the proportion of inefficient consultations, thereby enabling continuation of the clinical care process.

Intoxicación por monóxido de carbono: una causa rara de hipoacusia neurosensorial reversible / Reversible sensorineural hearing loss following carbon monoxide poisoning

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Easy Method for the Transformation of Levulinic Acid into Gamma-Valerolactone Using a Nickel Catalyst Derived from Nanocasted Nickel Oxide.

Different nickel catalysts have been tested for the transformation of levulinic acid into γ-valerolactone using an easy hydrothermal method, taking advantage of the properties of the high temperature water. A metallic nickel catalyst derived from NiO synthesized by a nanocasting procedure can achieve a productivity to γ-valerolactone, which is two orders of magnitude higher than that obtained by a commercial nickel catalyst. This nanocasted metallic nickel catalyst has shown bifunctionality as it is capable of activating water as the source for hydrogen and undertaking the further hydrogenation step. In contrast with metallic nickel, nickel oxide has shown to be incapable of transforming levulinic acid into γ-valerolactone.

Empleo de mallas biológicas en la reconstrucción inmediata posmastectomía. Primeros resultados y consideraciones / Use of biological mesh in immediate post-mastectomy reconstruction. Preliminary results

Objetivo: Presentamos nuestros resultados con el uso de mallas biológicas para la cobertura de los implantes en la reconstrucción mamaria posmastectomía. Pacientes y métodos: Se intervino a 40 pacientes consecutivas. La indicación fue de cáncer de mama en 29 casos y de forma profiláctica en 11. Se administró neoadyuvancia en 12 pacientes. Resultados: Hubo 8 necrosis cutánea, 8 seroma-derrames periprotésicos, 5 hematomas, 3 abscesos, 2 con dolor y 1 extrusión. Se reintervino a 12 pacientes (30%), y en 8 casos (20%) se llevó a cabo la retirada de malla y prótesis/expansor. La radioterapia previa tras una cirugía conservadora de inicio obligó a retirar la malla y la prótesis en todos los casos. Conclusión: La radioterapia y el volumen del implante son factores importantes para la aparición de complicaciones(AU)

Objective: This study describes the use of biological mesh in breast reconstruction and its results. Patients and methods: A study was conducted on 40 consecutive patients with mastectomy and immediate reconstruction with biological mesh and implants. The indication was breast cancer in 29 cases, and prophylactic in 11 patients. Neoadjuvant treatment was administered to 12 patients. Results: There were 8 skin necrosis, 8 perigraft seroma, 5 haematomas, 3 abscesses, 2 with pain and 1 extrusion. Twelve patients underwent surgery (30%) with removal of the mesh and implant /expander in 8 cases (20%). The mesh and the implant had to be removed in all cases were there had been conservative surgery followed by radiotherapy. Conclusions: Radiotherapy and implant volume are important factors for failed reconstruction(AU)

A de novo complete BRCA1 gene deletion identified in a Spanish woman with early bilateral breast cancer.

BACKGROUND: Germline mutations in either of the two tumor-suppressor genes, BRCA1 and BRCA2, account for a significant proportion of hereditary breast and ovarian cancer cases. Most of these mutations consist of deletions, insertions, nonsense mutations, and splice variants, however an increasing number of large genomic rearrangements have been identified in these genes. METHODS: We analysed BRCA1 and BRCA2 genes by direct sequencing and MLPA. We confirmed the results by an alternative MLPA kit and characterized the BRCA1 deletion by Array CGH. RESULTS: We describe the first case of a patient with no strong family history of the disease who developed early-onset bilateral breast cancer with a de novo complete BRCA1 gene deletion in the germinal line. The detected deletion started from the region surrounding the VAT1 locus to the beginning of NBR1 gene, including the RND2, ΨBRCA1, BRCA1 and NBR2 complete genes. CONCLUSION: This finding supports the large genomic rearrangement screening of BRCA genes in young breast cancer patients without family history, as well as in hereditary breast and ovarian cancer families previously tested negative for other variations.

A new aluminosilicate molecular sieve with a system of pores between those of ZSM-5 and beta zeolite.

A new aluminosilicate zeolite (ITQ-39) has been synthesized. This is an extensively faulted structure with very small domains that makes the structure elucidation very difficult. However, a combination of adsorption spectroscopy and reactivity studies with selected probe molecules suggests that the pore structure of ITQ-39 is related to that of Beta zeolite, with a three-directional channel system with large pores (12-MR), but with an effective pore diameter between those of Beta and ZSM-5, or a three-directional channel system with interconnected large (12-MR) and medium pores (10-MR). The pore topology of ITQ-39 is very attractive for catalysis and shows excellent results for the preparation of cumene by alkylation of benzene, while it can be a promising additive for FCC.

Impacto del tipo de hospital en el tratamiento y evolución de los pacientes con síndrome coronario agudo sin elevación del ST / Influence of hospital type on treatment and prognosis in patients with non-ST elevation acute coronary syndrome

Introducción y objetivos. Las guías de práctica clínica del síndrome coronario agudo sin elevación del ST (SCASEST) no valoran la infraestructura hospitalaria y la facilidad de acceso a la sala de hemodinámica. Este estudio analiza la influencia del tipo de hospital, con o sin sala de hemodinámica, en la forma de tratamiento de pacientes con SCASEST y su posible impacto en el pronóstico a medio plazo. Métodos. El GYSCA es un registro multicéntrico (15 hospitales) que analiza la aplicación de las guías en pacientes con SCASEST: 6 con sala de hemodinámica (hospitales centrales) y 9 sin hemodinámica (hospitales comarcales). Se realizó seguimiento clínico al alta y a los 3 y a los 12 meses. Resultados. Se reclutó a 1.133 pacientes consecutivos; 599 (52,9%) en hospitales centrales y 534 (47,1%) en hospitales comarcales. El uso de intervenciones de clase I fue mayor en los centrales (aspirina, clopidogrel, bloqueadores beta, IECA y estatinas; p < 0,01) y se revascularizó a más pacientes durante la hospitalización (el 43 frente al 30%; p < 0,01). El número de pacientes de hospitales comarcales que reingresaron por SCASEST al año fue 5 veces mayor que en los centrales (el 12,8 frente al 2,3%; p < 0,01), y el tipo de hospital fue uno de los predictores de eventos. Conclusiones. Los pacientes que ingresan por SCASEST en hospitales que no disponen de sala de hemodinámica son tratados de forma menos invasiva y con un tratamiento farmacológico menos ajustado a lo recomendado en las guías. Junto con los conocidos factores predictivos del pronóstico, el tipo de hospital puede tener un impacto adicional en la evolución (AU)

Introduction and objectives. Clinical practice guidelines on non-ST-segment elevation acute coronary syndrome (NSTEACS) do not take either hospital infrastructure or the availability of a catheterization laboratory into account. The aim of this study was to determine the influence of hospital type, either with or without a catheterization laboratory, on treatment and medium-term prognosis in patients with NSTEACS. Methods. The GYSCA multicenter study (covering 15 hospitals) investigated the implementation of clinical practice guidelines in patients with NSTEACS at six hospitals with catheterization laboratories (i.e. tertiary-care hospitals; THs) and nine without (i.e. secondary-care hospitals; SHs). Patients were assessed clinically at hospital discharge and after 3 and 12 months. Results. In total, 1133 consecutive patients were recruited: 599 (52.9%) in THs and 534 (47.1%) in SHs. The use of specific class-I interventions (i.e. aspirin, clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors and statins) was more common in THs (P < .01) and more patients in THs underwent revascularization while in hospital (43% vs. 30%; P < .01). The number of SH patients who were readmitted for NSTEACS at 1 year was 5-fold greater than the number of TH patients (12.8% vs. 2.3%; P < .01), and hospital type was a predictor of an adverse event. Conclusions. Patients admitted for NSTEACS to a hospital without a catheterization laboratory were managed less invasively and their drug treatment was less likely to have been modified to match guideline recommendations. In addition to other well-known prognostic factors, hospital type can also have an influence on patient outcomes (AU)

[Influence of hospital type on treatment and prognosis in patients with non-ST elevation acute coronary syndrome]. / Impacto del tipo de hospital en el tratamiento y evolución de los pacientes con síndrome coronario agudo sin elevación del ST.

INTRODUCTION AND OBJECTIVES: Clinical practice guidelines on non-ST-segment elevation acute coronary syndrome (NSTEACS) do not take either hospital infrastructure or the availability of a catheterization laboratory into account. The aim of this study was to determine the influence of hospital type, either with or without a catheterization laboratory, on treatment and medium-term prognosis in patients with NSTEACS. METHODS: The GYSCA multicenter study (covering 15 hospitals) investigated the implementation of clinical practice guidelines in patients with NSTEACS at six hospitals with catheterization laboratories (i.e. tertiary-care hospitals; THs) and nine without (i.e. secondary-care hospitals; SHs). Patients were assessed clinically at hospital discharge and after 3 and 12 months. RESULTS: In total, 1133 consecutive patients were recruited: 599 (52.9%) in THs and 534 (47.1%) in SHs. The use of specific class-I interventions (i.e. aspirin, clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors and statins) was more common in THs (P< .01) and more patients in THs underwent revascularization while in hospital (43% vs. 30%; P< .01). The number of SH patients who were readmitted for NSTEACS at 1 year was 5-fold greater than the number of TH patients (12.8% vs. 2.3%; P< .01), and hospital type was a predictor of an adverse event. CONCLUSIONS: Patients admitted for NSTEACS to a hospital without a catheterization laboratory were managed less invasively and their drug treatment was less likely to have been modified to match guideline recommendations. In addition to other well-known prognostic factors, hospital type can also have an influence on patient outcomes.

Incidence of Wra antigen and anti-Wra in a Spanish population.

BACKGROUND: This study reports the incidence of Wr(a) antigen and anti-Wr(a) in Valencia, Spain. STUDY DESIGN AND METHODS: The incidence of the Wr(a) antigen in 110,000 healthy blood donors was estimated. Likewise, the incidence of anti-Wr(a) was analyzed in a population consisting of 730 healthy blood donors, 356 pregnant women, and 581 patients who received transfusions from the area of Valencia, Spain. RESULTS: The incidence of Wr(a) antigen was 1 in 785. Overall, anti-Wr(a) was found in 59 samples: 20 healthy blood donors (1/37), 18 pregnant women (1/20), and 21 patients who received transfusions (1/28). The most frequent immunoglobulin class of anti-Wr(a) in healthy blood donors was immunoglobulin M, either alone (8 cases) or plus immunoglobulin G (IgG; 8 cases); the IgG1 and IgG3 were the IgG subclasses most frequently detected in pregnant women (12 cases) and in patients who received transfusions (12 cases). Only 51 percent of the anti-Wr(a) appeared to have the potential to be clinically significant. CONCLUSION: These data show that the incidence of Wr(a) antigen and anti-Wr(a) among the population from Valencia is similar to that reported in other European areas and suggest that the development of anti-Wr(a) is facilitated by the presence of a hyperactive immune system. The clinical relevance of anti-Wr(a) is limited, however.