Diagnóstico de síndrome de Brugada tras inyección subaracnoidea de prilocaína / Diagnosis of Brugada's syndrome after subarachnoid injection of prilocaine

El síndrome de Brugada es una enfermedad genética de transmisión autosómica dominante, que afecta a los canales iónicos de sodio, y que se caracteriza por bloqueo de rama derecha del haz de His y elevación del ST en precordiales derechas, en un corazón estructuralmente normal, y que se asocia a muerte súbita. Esta enfermedad puede ser desenmascarada por ciertos fármacos y cambios súbitos en el tono autonómico. Los anestésicos locales pueden aumentar los cambios en el ECG, por ser bloqueantes de canales de sodio, dependiendo, sobre todo, de la dosis y del tipo de anestésico. Se han reportado casos de cambios electrocardiográficos compatibles con síndrome de Brugada, desencadenados tras perfusión epidural o paravertebral de bupivacaína y ropivacaína. Presentamos un caso de un varón de 66 años, programado para hernioplastia inguinal de manera ambulatoria. No tenía historia de síncope ni de arritmias. Tras la anestesia intradural con 40mg de prilocaína presentó elevación del ST>2mm y bloqueo de rama derecha del haz de His en V1-V3 (AU)

Brugada syndrome is an autosomal dominant genetic disease affecting sodium ion channels. It is characterised by right bundle branch block and ST elevation in the right precordial leads, and with no structural cardiac abnormalities. It is associated with sudden death. This disease may be unmasked by certain drugs and sudden changes in autonomic tone. Local anaesthetics may increase ECG changes due to a blockade of the sodium channels, mainly depending on the dose and the type of anaesthetic. Thus, there have been reported electrocardiographic changes consistent with Brugada syndrome, triggered after epidural or paravertebral infusion of bupivacaine and ropivacaine. The case is described of a 66 years old man, scheduled for inguinal herniorrhaphy as an outpatient. He had no history of syncope or arrhythmias. After spinal anaesthesia with 40mg of prilocaine the ECG showed ST elevation>2mm, and right bundle branch block in V1-V3 (AU)

Diagnosis of Brugada's syndrome after subarachnoid injection of prilocaine. / Diagnóstico de síndrome de Brugada tras inyección subaracnoidea de prilocaína.

Brugada syndrome is an autosomal dominant genetic disease affecting sodium ion channels. It is characterised by right bundle branch block and ST elevation in the right precordial leads, and with no structural cardiac abnormalities. It is associated with sudden death. This disease may be unmasked by certain drugs and sudden changes in autonomic tone. Local anaesthetics may increase ECG changes due to a blockade of the sodium channels, mainly depending on the dose and the type of anaesthetic. Thus, there have been reported electrocardiographic changes consistent with Brugada syndrome, triggered after epidural or paravertebral infusion of bupivacaine and ropivacaine. The case is described of a 66 years old man, scheduled for inguinal herniorrhaphy as an outpatient. He had no history of syncope or arrhythmias. After spinal anaesthesia with 40mg of prilocaine the ECG showed ST elevation>2mm, and right bundle branch block in V1-V3.

Double-blind single-session neurofeedback training in upper-alpha for cognitive enhancement of healthy subjects.

This paper reports on a single-session neurofeedback (NF) training procedure on the user-specific upper alpha band for cognitive enhancement in healthy users. A double-blind study was designed using a NF group and an active control group. Control group performed as the NF group but received sham feedback, minimizing the non-specific factors of training. This design aimed to (i) investigate upper alpha as a NF parameter, (ii) evaluate the NF effects on upper alpha during the execution of a cognitive task, and (iii) evaluate the effects on cognitive performance by means of a cognitive task and a battery of psychological tests. Results of EEG analysis show the key role of the feedback: only the NF group enhanced upper alpha during the training, and it led to a desynchronization increase during the execution of the cognitive task. Regarding the behavioral results, a strong learning effect was observed, with the NF group performing better in almost all measurements but many of them without statistical significance.

Estudio de incidencia de los errores de medicación en los procesos de utilización del medicamento: prescripción, transcripción, validación, preparación, dispensación y administración en el ámbito hospitalario / Incident study of medication errors in drug use processes: prescription, transcription, validation, preparation, dispensing and administering in the hospital environment

Objetivo: Determinar la incidencia global y por etapas de los errores de medicación en 6 hospitales de Cataluña, así como los tipos de error y las consecuencias. Método: Diseño prospectivo, cuya variable global es el error de medicación. Se han excluido los errores potenciales. En cada hospital se estudiaron los ingresados en 2 unidades hasta 300 pacientes y se observaron 1.500 administraciones. Se aplicó la taxonomía del National Coordinating Council for Medication Error Reporting and Prevention. El error de prescripción se detectó mediante la revisión de las prescripciones, en la que se comprobaron paciente, medicamento, adherencia a protocolos, interacciones, contraindicaciones, omisión, duplicidad terapéutica, dosis, frecuencia, vía y falta de seguimiento. En la transcripción/validación se comprobó la coincidencia con la orden médica original. En la dispensación, antes de enviar los carros de unidosis, se revisó el contenido de los cajetines, y se contrastó con el listado generado informáticamente. En planta, los observadores comprobaron transcripción, preparación y administración. En todos los procesos se registraron los datos en una hoja específica. La concordancia entre revisores fue moderada (kappa = 0,525). Resultados: Se detectaron 16,94 errores por 100 pacientes-día y 0,98 por paciente: 16 % en prescripción, 27 % en transcripción/validación, 48 % en dispensación y 9 % en administración. El 84,47 % pertenecía a la categoría B (no se alcanzó al paciente), y menos del 0,5 % causaron daño. La población, de 65 años de media, se distribuyó en una relación varón/mujer de 60/40. Los principales grupos terapéuticos fueron: agentes contra la úlcera péptica y el reflujo gastroesofágico, antitrombóticos, y otros analgésicos y antipiréticos, en los que predominaba la forma farmacéutica (..) (AU)

Objective: To determine both the global Incident, and the Incident for stages of medication errors in six Catalonian hospitals, the types of error and the consequences. Method: A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1,500 administrations were observed. The NCCMERP taxonomy was applied. The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa = 0.525). Results: 16.94 errors were detected per 100 patients-day and 0.98 errors per patient: 16 % in prescription, 27 % in transcription/validation, 48 % in dispensing, and 9 % in administration. 84.47 % were category B errors (they did not reach the patient), and < 0.5 % of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, (..) (AU)

[Incident study of medication errors in drug use processes: prescription, transcription, validation, preparation, dispensing and administering in the hospital environment]. / Estudio de incidencia de los errores de medicación en los procesos de utilización del medicamento: prescripción, transcripción, validación, preparación, dispensación y administración en el ámbito hospitalario.

OBJECTIVE: To determine both the global Incident, and the Incident for stages of medication errors in six Catalonian hospitals, the types of error and the consequences. METHOD: A prospective design, with the global variable of the medication error. Potential errors have been excluded. The patients admitted to each hospital were studied in 2 groups of up to 300 patients and 1,500 administrations were observed. The NCCMERP taxonomy was applied. The prescription error was detected through the review of prescriptions, checking the patient, medication, adherence to protocols, interactions, contraindications, omission, duplicated therapy, doses, frequency, method, and lack of follow-up. During the transcription/validation, it was verified that the prescription matched the original order. In the dispensing process, the content of the drawers was checked, comparing it to the computer generated list, before sending out the single dose trolley. The transcription, preparation and administration were observed on the wards. The information for all the procedures was registered in a specific data sheet. There was moderate concordance amongst the inspectors (kappa = 0.525). RESULTS: 16.94 errors were detected per 100 patients-day and 0.98 errors per patient: 16 % in prescription, 27 % in transcription/validation, 48 % in dispensing, and 9 % in administration. 84.47 % were category B errors (they did not reach the patient), and < 0.5 % of the errors were harmful. The population, with an average age of 65, had a male/female ratio of 60/40. The principal therapeutic groups were: agents against peptic ulcer and GERD, antithrombotic agents, and other analgesics and antipyretics, principally in a solid oral drug form (58 %). The medications per patient-day were 5.5 and the units of medication were on average 11.21, varying greatly among the institutions. The adjustment of 10 units made the results more uniform. In all the stages, omission was the most frequent error. DISCUSSION: The different methods used and different areas of the investigations make comparisons difficult. This is evident in the harmful errors, the proportion of which is affected by the detection procedure. The number of mistakes avoided during the execution of this project demonstrates the need to improve the planning of the work systems and to establish safety measures.

Consejo breve para la prevención del tabaquismo en escolares de 2º a 4º de Educación Secundaria Obligatoria de Zaragoza / No disponible

Se realizó una intervención en el ámbito escolar para administrar consejo breve antitabacoa escolares de la Educación Secundaria Obligatoria (ESO) en Zaragoza durante los cursos2006-2007 y 2007-2008. Los objetivos del estudio fueron medir la efectividad del consejobreve apoyado por material escrito y estudiar la progresión del tabaquismo. El estudióincluyó una encuesta autoadministrada y una coximetría, así como una reevaluación un añodespués.Se estudiaron 15 centros escolares, 8 del grupo intervención y 7 de control. Se administróconsejo apoyado con un folleto frente al control en el que no se utilizaba el folleto. Laasignación a los grupos no fue aleatoria.Se evaluaron 1.720 estudiantes entre los dos cursos 2006-07 y 2007-08 de los cuales51,95% fueron hombres y 48,5% mujeres. La edad media fue 14,6 años (desviación estándar[DE] = 1,36) y fueron fumadores el 19,7%. Entre las mujeres fueron fumadoras el24,7% frente al 18,3% de los hombres (p < 0,0001). No hubo diferencias significativas parael tabaquismo según grupo de intervención o control. La progresión del tabaquismo crecióun 8,8% en el grupo intervención frente a un 12% en el de control entre 2.º y 3.º. Las diferenciasfueron 3% para el grupo intervención frente al 1,1% en el de control entre 3.º y 4.º,no siendo estas diferencias estadísticamente significativas. Conclusiones: el porcentaje de fumadores en escolares de ESO es del 19,7%. La escaladade consumo se produce entre 2.º y 3.º. No se demostró una mayor efectividad del consejobreve mediante el uso de un folleto(AU)

Authors report a community school study about smoking adolescent behaviour, 8º, 9º,and 10 º year in Zaragoza (Spain). The study was implemented in the 2006-2007 and 2007-2008 courses respectively. The study’s objectives were to asses the effectiveness of smokingcounselling with the aid of a specifically designed leaflet. The study also included an evaluationof expired CO. The authors surveyed on smoking behaviour as well as on personaldetails of the students.The study includes 8 intervention schools and 7 control schools. Allocation wasn’t randomizeddue to logistic reasons. The interventional group received advice against smokingby means of spoken counsel from a professional supported by a leaflet. The control grouponly received the spoken counsel. The expired CO was assessed in each group. The counselwas repeated in each group one year later to the same students.In all 1,720 students were assessed: 51.95% men and 48.5% women. The median ageof the students was 14.6 years SD: 1.36. The authors found that 19.7% of the students weresmokers. The distribution of smokers by sex was 24.7% of women versus 15.3% of men X2= 24.1 p < 0.0001. Smoking behaviour between interventional or control group wasn’t statisticallydifferent.Conclusions: There wasn’t any evidence of effectiveness in using a leaflet added to thespoken counsel. Prevalence of smoking was very high: 19.7% among adolescents of Zaragoza.The study shows a increase of smoking between 8º and 10º(AU)

Estudio epidemiológico sobre el consumo de tabaco en adolescentes de 2º y 3º de ESO en Zaragoza / No disponible

Objetivo: analizar el consumo de tabaco en adolescentes de Zaragoza de 2.º y 3.º de laEducación Secundaria Obligatoria (ESO).Material y métodos: población diana: adolescentes de 2.° y 3.° de ESO. Ámbito: centros escolares.Consejo impartido de forma grupal por profesionales de Atención Primaria: pediatras ymédicos de familia. Marco: 14 centros escolares de la ciudad de Zaragoza. Participación voluntariay de asignación no aleatoria de los Centros. Muestra: 881 adolescentes. Actividad en elGrupo Intervención: consejo grupal apoyado con material escrito específico; folleto encuesta decinco preguntas y coximetría. Reevaluación: encuesta y coximetría un año después a los mismoscentros y en los cursos 3.° y 4.° de ESO.Resultados principales: se objetivó un porcentaje de fumadores de un 18,8% en el totalde la muestra (IC 95% 16,3%-21,6%). La media de edad de los fumadores es de 14,8 años yla de los no fumadores de 14,2 años. El consumo de las mujeres es mucho mayor que el delos hombres, 24,6% frente al 14%. El ascenso en las cifras de consumo es mayor en las mujeres,alcanzando porcentajes de un 40% a los 16 años. Un 34% de los 166 fumadores piensanno fumar el próximo año. Los centros públicos tienen unas cifras de consumo superior al delos concertados y al de los privados (13,6% tanto para centros privados como concertados, y 22,9% para los públicos), siendo estas diferencias significativas (X2=11,5; p=0,003). Sin embargo,si analizamos el caso de las mujeres de 3.° de ESO vemos que estas diferencias sonmenores y no alcanzan significación estadística. El patrón de consumo en fin de semana esmás acentuado para los hombres que para las mujeres. Cuando las lecturas de monóxido decarbono superan los valores de 5 partes por millón (ppm) la probabilidad de ser fumador esde alrededor del 80%

Objective: to evaluate the adolescent smoking habit in a whole group at school by primary health care practitioners.Target population: students of 2nd and 3rd level of High Education (Obligatory SecondaryEducation). Scenary: 14 High Schools in Zaragoza city. The recruitment was not randomisedand students have participated voluntarily. Professionals: General Pactitioners and Pediatricians.Sample: 881 students. Activities: groupal antismoking advice, leaflet, five questions inquiryand coximetry. Reevaluation: one year later inquiry and coximetry.Main results: the authors report 18.80% (CI 95% 16.3%-21.6%) of smokers in all thesample. Women smoke more than men 24.60% versus 14%. Smoking is a crescent phenomenonin young women 40% at sixteen years of age. 34% of smokers do not have the intention ofsmoking next year. Students in Public High Schools smoke more than students in Private andConcerted High Schools, 22.90% versus 13.70% (X2=11.5; p=0.003). Otherwise women behavein a similar way in both kinds of schools. Smoker students are 14.8 years old and no smokerstudents are 14.2 years old. The patern of consume of men is mainly at weekends. When coximetryis more than 5 ppm, the probability of being a smoker is 80%