Eficacia y seguridad del tratamiento antibiótico domiciliario endovenoso en pacientes con patología infecciosa procedentes del servicio de urgencias / Safety and efficacy of home intravenous antibiotic therapy for patients referred by the hospital emergency department

Objetivo: Analizar la eficacia y seguridad del tratamiento antibiótico domiciliario endovenoso (TADE) en infecciones de pacientes procedentes del servicio de urgencias. Método: Estudio prospectivo de los pacientes ingresados para TADE en la unidad de hospitalización a domicilio (HaD) del Hospital de Sabadell entre enero del 2008 a junio del 2011. Se comparan dos grupos: pacientes derivados desde urgencias frente a pacientes procedentes de otros dispositivos asistenciales. Las variables analizadas fueron edad, sexo, estancia media, índice de Barthel, vía y forma de administración del antibiótico, tipo de infección, microorganismo aislado, antibiótico utilizado, índices de reingreso precoz y tardío y complicaciones médicas y asociadas al acceso venoso. El TAD Ese autoadministró por parte del cuidador y/o el paciente mediante dispositivos de infusión elastoméricos. Resultados: Se reclutaron 409 pacientes que generaron 492 episodios de TADE, 92 (..) (AU)

Objective: To analyze the safety and efficacy of home intravenous antibiotic therapy (HIVAT) for patients with infections discharged from the emergency department and referred to the home hospital program. Methods: Prospective study of patients referred to the home hospital program of Hospital de Sabadell for HIVAT between January 2008 and June 2011. We compared 2 groups: patients referred by the emergency department and patients referred by any other department or service. Variables analyzed included age, sex, mean stay in the program, Barthel index, route and method for administering the antibiotic, type of infection, microorganism isolated, antibiotic prescribed, early and late readmission rates, and complications (medical and those associated with venous access). HIVAT was self-administered by the patient (or home caregiver) through an elastomeric infusion device. Results: We studied 409 patients and 492 courses of HIVAT; 92 patients were referred by the emergency department and400 came from other care units. Emergency patients were older, had greater functional impairment, a shorter stay in the (..) (AU)

Rotura subcapsular hepática espontánea en embarazada. Asociada a síndorme de hellp tipo I / Spontaneous subcapsular hepatic rupture in pregnancy, associated a type i hellp syndrome

El síndrome de HELLP es una entidad rara durante el embarazo que puede ocasionar complicaciones como la formación y rotura de un hematoma subcapsular hepático y sus graves consecuencias materno-infantiles. Se hace un resumen de su etiopatogenia, diagnóstico clínico-analítico y diferencial, sus complicaciones y el manejo médico-quirúrgico. Asimismo se realiza una revisión bibliográfica de esta patología (AU)

HELLP syndrome is a rare entity during pregnancy that can cause the formation and rupture of a subcapsular hepatic hematoma with severe consequences for the mother and newborn. We present a resume of the pathophysiology, diagnosis, complications and medical and surgical treatment. A resume of the literature is also presented (AU)

Effect of malting conditions and quality characteristics of malt and roasted malt extract from 'acha' grains (Digitaria exilis Stapf).

BACKGROUND: Considering the importance of malting and roasting on the quality of 'acha' beverages, a study was conducted to find optimum conditions for malting and the production of a high-quality roasted extract that could be used for an 'acha' beverage. RESULTS: The data obtained were analysed using response surface methodology. The results revealed that the most significant (P < 0.05) malting factors that affect the response variables were the linear terms of germination time and drying temperature. However, for the extract production, the linear term of roasting temperature was the most significant (P < 0.05) factor. The quadratic and interaction terms exhibited significant (P < 0.05) effect in all cases apart from the flavour. CONCLUSION: The overall optimum regions were established at 28 h of germination time, 55 degrees C drying temperature and 5.0% moisture content for the malting conditions while for the extract production, a roasting temperature of 210 degrees C, extraction temperature of 70 degrees C and extraction duration of 20 min were established.

[Use of antidepressant treatment. Patients' perception]. / Uso de los tratamientos antidepresivos. La percepción del paciente.

INTRODUCTION: A major determinant of response to antidepressant drugs is how the patients use them. Our objective is to take a look over the antidepressants use in a real sample. METHODS: In determining which factors may be relevant for treatment good use, social, demographic, disease and treatment-related data were gathered from 550 patients, who were currently taking antidepressants for any motive. The questionnaire included two items, the patients' perceived difficulty of following treatment and the level of acknowledged non-compliance by the patient, which may be considered as both an indirect and guiltless way of approximating the patients' real use of treatment. RESULTS: Compliance was poor among the less educated, as well as those living in rural areas and in patients receiving concomitant treatment for organic diseases. Use was good in 61.5% and was particularly good among those with an affective disorder (69.8%). Among patients who did not respond to treatment, the incidence of non-compliance (49.1%) was higher than for those achieving improvement (31.2%). CONCLUSIONS: It's important to explore and reinforce a good use of antidepressants in clinical settings and to be sure this type of treatment is necessary if the indication is not clear.

Uso de los tratamientos antidepresivos. La percepción del paciente / Use of antidepressant treatment. Patients’ perception

Introducción. Un determinante fundamental de la respuesta al tratamiento antidepresivo es cómo el paciente lo toma. Nuestro objetivo es observar el uso de los antidepresivos en una muestra real de pacientes. Métodos. Para determinar que factores pueden ser relevantes para un buen uso del tratamiento se recogieron datos sociales, demográficos, relativos a la enfermedad y al tratamiento de 550 pacientes que estaban siendo tratados con antidepresivos por cualquier motivo. El cuestionario elaborado incluía dos ítems, la dificultad percibida por el paciente para seguir las indicaciones del tratamiento y el nivel de reconocimiento de falta de cumplimiento, lo que puede ser considerado como una forma indirecta y poco culpabilizadora de aproximarse al uso real del medicamento por parte del paciente. Resultados. El cumplimiento fue peor en el grupo con un nivel inferior de educación, así como en aquellos que vivían en zonas rurales y en los que recibían otro tratamiento concomitante para enfermedades orgánicas. El uso era bueno en el 61,5 % y, particularmente bueno, entre aquellos diagnosticados de un trastorno afectivo (69,8%). Entre los pacientes que no respondían al tratamiento, la incidencia del no-cumplimiento (49,1%) era superior a aquellos que sí referían haber mejorado (31,2%).Conclusiones. Es importante explorar y reforzar un buen uso del tratamiento antidepresivo en todos los dispositivos asistenciales y estar seguro de que este tipo de tratamiento es necesario si la indicación no está clara (AU)

Introduction. A major determinant of response to antidepressant drugs is how the patients use them. Our objective is to take a look over the antidepressants use in a real sample. Methods. In determining which factors may be relevant for treatment good use, social, demographic, disease and treatment-related data were gathered from 550 patients, who were currently taking antidepressants for any motive. The questionnaire included two items, the patients’ perceived difficulty of following treatment and the level of acknowledged non-compliance by the patient, which may be considered as both an indirect and guiltless way of approximating the patients’ real use of treatment. Results. Compliance was poor among the less educated, as well as those living in rural areas and in patients receiving concomitant treatment for organic diseases. Use was good in 61.5% and was particularly good among those with an affective disorder (69.8%). Among patients who did not respond to treatment, the incidence of non-compliance (49.1%) was higher than for those achieving improvement (31.2%).Conclusions. It’s important to explore and reinforce a good use of antidepressants in clinical settings and to be sure this type of treatment is necessary if the indication is not clear (AU)

Prevalence and comorbidity of common mental disorders in primary care.

OBJECTIVE: To estimate the prevalence and comorbidity of the most common mental disorders in primary care practice in Spain, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. DESIGN: A systematic sample of 7936 adult primary care patients was recruited by 1925 general practitioners in a large cross-sectional national epidemiological study. The PRIME-MD was used to diagnose psychiatric disorders. SETTING: 1356 primary care units proportionally distributed throughout the country. RESULTS: 53.6% of the sample presented one or more psychiatric disorder. The most prevalent were affective (35.8%), anxiety (25.6%), and somatoform (28.8%) disorders. 30.3% of the patients had more than one current mental disorder. 11.5% presented comorbidity between affective, anxiety, and somatoform disorders. CONCLUSIONS: The study provides further evidence of the high prevalence and high comorbidity of mental disorders in primary care. Given the large overlap between affective, anxiety and somatoform disorders, future diagnostic classifications should reconsider the current separation between these entities.

[Analysis of a series of 55 patients with biopsy proven giant cell temporal arteritis]. / Análisis de una serie de 55 pacientes con arteritis de células gigantes confirmada por biopsia.

INTRODUCTION: Our main aim with this study is to establish the epidemiologic and clinical features, treatment response and complications of a group composed of 55 patients with biopsy proven temporal arteritis in a local hospital. MATERIAL AND METHODS: Retrospective study based on clinical records revision of patients diagnosed of giant cell arteritis (GCA) made by temporal artery biopsy between 1989 and 2001. RESULTS: The approximated annual incidence of GCA in our area is 4.1 cases per 100,000 persons over the age of 50. The mean age at diagnostic was 74 years and the 78,2% were women. The most common symptom at diagnostic was headache (81.5%) followed by systemic manifestations (74.1%) and later we found jaw claudication (32,7%), visual impairment (30.2%), isquemic manifestations (17%). Polymyalgia rheumatica was associated to GCA in 49.1% of cases. The temporal artery explorations was abnormal in the 76.9% of patients. The mean initial dose of corticoids was 69 mg prednisone per day, with a half dose reduction time of .5 months. In spite of that, 24,1% of patients relapsed during the first year. The 38% of patients did some complications during the corticosteroid treatment. The ESR was lower 50 mm in 12.7% of patients; it was anaemia in the 37.7% and thrombocytosis in 32,1%. In these last patients we detected a relation between thrombocytosis and specific visual impairment. CONCLUSIONS: The incidence of GCA in our area is low. The results of our series aren't different from others publicated before in clinical manifestations, there is a prevalence of female sex and there is a relation between specific visual impairment and the presence of thrombocytosis.

Análisis de una serie de 55 pacientes con arteritis de células gigantes confirmada por biopsia / Analysis of a serie of 55 patients with biopsy proven giant cell temporal arteritis

Introducción: Descripción de las características epidemiológicas, clínicas, respuesta al tratamiento y complicaciones de una serie de 55 pacientes con arteritis de células gigantes(ACG) confirmada por biopsia en un hospital comarcal. Material y métodos: Estudio retrospectivo de los pacientes diagnosticados de ACG por biopsia de arteria temporal en el periodo comprendido entre 1989 y 2001 en nuestro centro. Resultados: La incidencia anual aproximada calculada en nuestra área sería de 4,1 casos por 100.000 habitantes mayor de 50 años. La edad media al diagnóstico fue de 74 años y un 78,2 por ciento eran mujeres. El síntoma más frecuente al diagnóstico fue la cefalea (81,5 por ciento), seguido de las manifestaciones sistémicas (74,1 por ciento), a más distancia se encontraba la claudicación mandibular (32,7 por ciento), trastornos visuales (30,2 por ciento), manifestaciones isquémicas (17 por ciento). La polimialgia reumática se asoció a ACG en el 49,1 por ciento. La palpación de arteria temporal fue anormal en el 76,9 por ciento de los pacientes. La dosis media de inicio de tratamiento fue de 69 mg prednisona /dia, con una media de tiempo de reducción a mitad de dosis fue de 3,5 meses. Un 24,1 por ciento de los pacientes presentaron un rebrote durante el primer año. Un 38 por ciento de los pacientes presentaron complicaciones durante el tratamiento corticoideo. La VSG fue inferior a 50 mm en el 12,7 por ciento de los pacientes, existía anemia en el 37,7 por ciento y trombocitosis en el 32,1 por ciento. En estos últimos se detectó una tendencia a la relación con presencia de alteraciones visuales específicas. Conclusiones: La incidencia de ACG en nuestra área estaría dentro de las zonas de baja incidencia. Los resultados de nuestra serie no difieren de otras descritas previamente en la literatura en cuanto a las manifestaciones clínicas de los pacientes, existe un claro predominio del sexo femenino y se detecta una tendencia a la relación de alteraciones visuales específicas con presencia de trombocitosis (AU)

Inefficacy of burst-suppression anesthesia in medication-resistant major depression: a controlled trial.

Burst-suppression anesthesia (BSA) has been previously compared with electroconvulsive therapy (ECT) in drug-resistant depression, with promising results. We have carried out a double-blind randomized clinical trial comparing BSA with sham-BSA in 20 patients meeting DSM-IV criteria for major depression with inadequate response to antidepressant drugs and who chose BSA as an alternative to ECT. After withdrawing antidepressant drugs, patients were randomized to receive four sessions of either BSA (induction with propofol followed by the anesthetic agent sevoflurane, achieving BSA for 1 hour) or sham-BSA (induction with propofol until loss of consciousness, followed by spontaneous awakening in 5-10 minutes). Decrease in the Hamilton Rating Depression Scale was larger with BSA (-6.0 +/- 7.3) than with sham-BSA (-2.5 +/- 4.5), but differences did not reach statistical significance ( t = -1.08, p = 0.3). In our sample, we have not found BSA to be superior to sham-BSA and therefore cannot consider BSA as an alternative to ECT.

Structure and cytotoxicity of new polyhydroxylated sterols from the Caribbean gorgonian Plexaurella grisea.

The gorgonian Plexaurella grisea contains the new steroids 9-hydroxygorgosterol (1), 9,11 alpha,14-trihydroxygorgosterol (2), 5 beta,6 beta-epoxyergost-24(28)-ene-3 beta,7 beta-diol (3), ergost-24(28)-ene-3 beta,5 alpha,6 beta,7 beta-tetrol (4), an unseparable 1:1 mixture of the epimers (25R) and (25S)-26-acetoxy-3 beta,5 alpha-dihydroxyergost-24(28)-en-6-one (5/6), and seven related, known compounds (7-13). The structures of these new compounds were defined by spectroscopic analysis. All the compounds (1-13) isolated from P. grisea were tested against P 388, A 549, and HT 29 tumor cell lines. Compounds 3, 5/6, and 12 exhibited selective activity against the HT 29 cell line (ED(50) = 0.1 microg/ml).

New acyclic sesquiterpenes and norsesquiterpenes from the Caribbean Gorgonian Plexaurella grisea.

The gorgonian Plexaurella grisea from Punta Cana, Dominican Republic, contains five new acyclic sesquiterpenes, (3E,5E)-3,7,11-trimethyl-9-oxododeca-1,3,5-triene (3), (3Z,5E)-3,7,11-trimethyl-9-oxododeca-1,3,5-triene (4), (3E)-6-acetoxy-3,11-dimethyl-7-methylidendodeca-1,3,10-triene (5), (3E,5E)-7-hydroxy-3,7,11-trimethyldodeca-1,3,5,10-tetraene (6), and (3E,5E,9E)-8,11-diacetoxy-3,7,11-trimethyldodeca-1,3,5,9-tetraene (7), and two new linear norsesquiterpenes, (2E,4E,7Z)-2,6,10-trimethylundeca-2,4,7,9-tetraenal (8) and (2E,4E)-2,6,10-trimethylundeca-2,4,9-trienal (9), in addition to the known compounds 1, 2, and 10. The structures of the new compounds 3-9 were elucidated by interpretation of spectroscopic data. In general, the new compounds are mildly cytotoxic against tumor cell lines, and although norsesquiterpene 8 was inactive, norsesquiterpene 9 exhibited the greatest and selective activity against the P-388 tumor cell line.

Psychopathology and the binding problem.

Normal cerebral activity is based on the rapid and flexible alternation of an enormous quantity of spatial-temporal patterns of neuronal firing. There is still much to learn about the mechanism that keeps neurons on functionally closed assemblies firing in synchronization. The explanation of this mechanism is the so called 'binding problem', one of the cornerstones of the generation of perceptions, cognitions, emotions and behaviours by the brain, and therefore of great interest to psychiatry. We explore the possibility that a 'binding dysfunction' could be a relevant aspect of the pathophysiology of mental disorders, and apply it to schizophrenia, in an attempt to integrate some neurobiological findings in this disorder, including a few preliminary data obtained with transcranial magnetic stimulation (TMS).

[Optimization of electroconvulsive therapy. Strategies for an adequate convulsion: role of caffeine]. / Optimización de la terapia electroconvulsiva. Estrategias para una adecuada convulsión: papel de la cafeína.

The Electroconvulsive Therapy is a widely used technique in psychiatry as a treatment for several mental disorders with particular indications. To produce therapeutic effect it's necessary to induce a convulsion which is considered adequate if its duration lasts more than 20 seconds. Considerations that should be taken in to account and possible enhancement strategies when convulsion is not adequate are revised in the present article. Among these strategies we focus on the specific role of caffeine as convulsion enhancer and on aspects related to its use and administration form.

Optimización de la terapia electroconvulsiva. Estrategias para una adecuada convulsión: papel de la cafeína / Optimization of electroconvulsive therapy. Strategies for an adequate convulsion. Role of caffeine

La terapia electroconvulsiva es una técnica ampliamente utilizada en psiquiatría como tratamiento de diversas enfermedades mentales, con unas indicaciones precisas. Para que se produzca un efecto terapéutico es necesaria la inducción de una convulsión que se estima adecuada si su duración es superior a 20 segundos. En el presente artículo se realiza una revisión de las consideraciones a tener en cuenta, y de las estrategias de potenciación cuando no se consigue que la convulsión sea adecuada. Dentro de estas estrategias nos centramos en el papel específico de la cafeína como potenciador de la convulsión, y aspectos referentes a su uso y forma de administración (AU)

Seizure activity and safety in combined treatment with venlafaxine and ECT: a pilot study.

Some authors have described the combined use of ECT and psychotropic drugs, emphasizing possible interactions and synergisms of this combined therapy. We are unaware of reports of the concurrent use of the new antidepressant venlafaxine with ECT. The goals of our study were to assess the possible effects of venlafaxine on seizure length during ECT and the possible cardiovascular effects of this combined treatment. Nine severely ill, depressed patients were treated simultaneously with bilateral ECT and venlafaxine 150 mg/day and were compared with nine control, depressed subjects taking tricyclic antidepressants (TCA) and ECT. No patients had prolonged seizures and no spontaneous/tardive seizures outside ECT were observed. With regard to mean seizure length, no statistically significant differences were observed between the control group and the venlafaxine group. Neither significant increases in arterial blood pressure nor electrocardiographic recording abnormalities were found in venlafaxine patients when compared with the tricyclic group. Even though the small number of patients used is a significant limitation of this study, we found that combined venlafaxine and ECT appears to be safe when used in depression.

Isolation and structure elucidation of new cytotoxic steroids from the gorgonian Leptogorgia sarmentosa.

The gorgonian Leptogorgia sarmentosa contains three new steroids, (20S)-20-hydroxycholestane-3,16-dione (1), (16S, 20S)-16,20-dihydroxycholestan-3-one (2), and (20S)-20-hydroxycholest-1-ene-3,16-dione (3) together with a known related compound (4). Their structures were defined by spectroscopic analysis. The new steroids exhibited significant cytotoxicity against four tumor cell lines (ED50 = 1 microg/ml).

[Management and treatment of severe mental disorders in pregnancy]. / El manejo y el tratamiento de los trastornos mentales graves en la embarazada.

The pharmacological treatment of serious mental disorders in the pregnancy, supposes a clinical dare by the possible repercussions on the fetus and the pregnancy: theratogenesis, perinatal syndrome or postnatal sequels in the development. The electroconvulsive therapy (ECT) as much takes implicit a minimum risk for the mother as for the fetus and therefore, it must be located in the highest positions of the therapeutic decision trees. In the present article, are reviewed the consequences of the pharmacological treatment and the ECT in the serious mental disorders during the pregnancy. Is referenced to all of the pharmacological groups and with respect to the ECT: their indications, counterindications, complications and technical procedures advisables. Finally is reviewed the guide line for each syndromical group of psychiatric diseases.

Mental disorders on the island of Formentera: prevalence in general population using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN).

BACKGROUND: The aims of this two-stage epidemiological study were: to determine the prevalence of psychiatric disorders in the general population of the island of Formentera (Balearic Isles, Spain); to provide reference data for subsequent health care planning; and to test a relatively new assessment instrument, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), in a community study. METHOD: It was designed as a cross-sectional two-stage community study using the General Health Questionnaire (GHQ-28) at stage one (N = 697), and the SCAN at stage two (N = 242). RESULTS: Estimated prevalence of disorders was 21.4% according to the ICD-10 classification system. Neurotic and somatoform disorders were the most prevalent, followed by substance-related, sleep and mood disorders. Total prevalence of mental disorders showed no significant differences according to sex. As regards age, mood and anxiety disorders were most prevalent in the 30- to 50-year age group, and sleep disorders were more prevalent in the older group. CONCLUSION: Prevalences of mental disorders in Formentera are higher than those found in two-stage studies in other countries and similar to those found in most studies in Spain, despite the variety of the instruments used.