46 research outputs found
Desprescripción de antipsicóticos utilizados para tratar los síntomas psicológicos y conductuales en pacientes con demencia de moderada a grave
La demencia es una enfermedad en las que los pacientes suelen experimentar a lo largo de su
curso al menos un síntoma comportamental o psicológico (BPSD, de sus siglas en inglés). Para
su man
ejo se recomienda estrategias no farmacológicas como primera línea. En caso de que
estas fallen o los síntomas neuropsiquiátricos sean muy severos, se recurre a los antipsicóticos.
Debido a los inconvenientes derivados del uso de estos fármacos a largo pla
zo, se desarrollan
estrategias de desprescripción con el objetivo de mejorar la calidad de vida del paciente.
Con el objetivo de conocer el estado general de la evidencia científica sobre la desprescripción
de antipsicóticos en demencia, se ha realizado un
a revisión sistemática haciendo uso de las
principales bases de datos, con una pregunta de investigación en formato estructurado PICO
(Paciente, Intervención, Comparación y Resultado (Outcome)), en el periodo comprendido entre
1 enero de 2014 hasta el 30 d
e abril de 2019. Por otro lado, se identificaron aquellos pacientes
del Centro Sociosanitario Heliópolis con prescripción activa de antipsicóticos, aplic
á
ndoles los
criterios descritos en el Protocolo de Desprescripción de la Junta de Andalucía.
La despre
scripción ha sido posible en el 36% de los pacientes seleccionados, disminuyendo la
dosis a la mitad en el 100% de los pacientes. El 66.67% presentaban algún efecto adverso
derivado del uso de antipsicóticos en el momento de la desprescripción. Los síntoma
s
neuropsiquiátricos más frecuentes por los que fueron prescritos son la irritabilidad y labilidad.
Tras la desprescripción se observa disminución de los efectos adversos.
La disminución de dosis parece ser beneficiosa para el paciente. Para conseguir est
os objetivos
se recomienda seguir guías de práctica clínica o algoritmos de tratamiento con evidencia
científica. Finalmente, destacar con este trabajo la ayuda del farmacéutico formando parte de un
equipo multidisciplinar en el proceso de desprescripción.Universidad de Sevilla. Grado en Farmaci
Outpatient Management of Malignant Pleural Effusion Using a Tunneled Pleural Catheter: Preliminary Experience
Inpatient management of malignant pleural effusion
includes the placement of a conventional thoracostomy tube
for drainage and talc slurry pleurodesis and/or a surgical
approach consisting of video-assisted thoracoscopic talc
insufflation. Both techniques require prolonged hospital
stays of up to 1 week. Unfortunately, life expectancy in
patients with this disease does not usually exceed 6 months,
and so the primary aim of any palliative intervention
intended to improve quality of life should be to avoid
hospital admissions and to relieve pain as far as possible.
Of the few outpatient alternatives to hospital management
the most frequently used is repeated thoracentesis. We
describe the outpatient management of malignant pleural
effusion by placement of a tunneled pleural catheter in a
patient with stage IIIB lung adenocarcinoma. In our
opinion, the use of this catheter offers a viable alternative to
conventional therapy and is better tolerated
Lesiones traqueales focales. A propósito de un caso
Presentamos un caso de carcinoma adenoide quístico de tráquea
demostrado mediante TC multidetector de 64 coronas, PET-TC, y co-
rrelación anatomopatológica, en un paciente con hemoptisis. En este
artículo revisamos el diagnóstico diferencial de las lesiones traqueales
únicas focales mediante tomografía computarizada (TC). Las técnicas
de imagen permitieron el diagnóstico e infravaloraron la invasión de la
pared traqueal en este caso, confi
rmada con posterioridad mediante el
estudio histológico. INGLÉS: We present a case of adenoid cystic tracheal carcinoma detected by computerized tomography (64-MDCT) with cyto-histological correlation in a patient with hemoptysis. In this article we review the differential diagnosis of solitary focal tracheal lesions as they appear in computerized tomography (CT). In this case, image methods suggested the diagnosis but underestimated the tracheal wall invasion, which was established by histologycal examination of the resected tumor
Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients
Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance
to leptin has been consistently associated with obesity. Raised leptin levels
have been reported in subjects with sleep apnoea or obesity-hypoventilation
syndrome. The aim of the present study was to assess, by multivariate analysis,
the possible association between respiratory centre impairment and levels of
serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2))
underwent the following tests: sleep studies, respiratory function tests,
baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute
ventilation), fasting leptin levels, body composition and anthropometric
measures. Subjects with airways obstruction on spirometry were excluded. Out of
the 346 subjects undergoing testing, 245 were included in the current analysis.
Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension,
percentage body fat and minimal nocturnal saturation were predictors for baseline
P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin
levels were predictors for hypercapnic response in males, but not in females.
Hyperleptinaemia is associated with a reduction in respiratory drive and
hypercapnic response, irrespective of the amount of body fat. These data suggest
the extension of leptin resistance to the respiratory centre
Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study
Electromagnetic navigation bronchoscopy (ENB) has been developed as a
novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules.
Despite successful navigation in 90% of patients, ENB diagnostic yield does not
generally exceed 70%. We sought to determine whether the presence of a bronchus
sign on CT imaging conditions diagnostic yield of ENB and might account for the
discrepancy between successful navigation and diagnostic yield. METHODS: We
conducted a prospective, single-center study of ENB in 51 consecutive patients
with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique
in patients with a high surgical risk, suspected metastatic disease, or
advanced-stage disease, or in those who demanded a preoperative diagnosis prior
to undergoing curative resection. We studied patient and technical variables that
might condition diagnostic yield, including size, cause, location, distance to
the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the
presence of a bronchus sign on CT imaging; registration point divergence; and the
minimum distance from the tip of the locatable guide to the nodule measured
during the procedure. RESULTS: The diagnostic yield of ENB was 67% (34/51). The
sensitivity and specificity of ENB for malignancy in this study were 71% and
100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus
sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign.
Univariate analysis identified the bronchus sign (P = .005) and nodule size (P =
.04) as statistically significant variables conditioning yield, but on
multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95%
CI, 1.8-31.7). No procedure-related complications were observed. CONCLUSIONS: ENB
diagnostic yield is highly dependent on the presence of a bronchus sign on CT
imaging
Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD
Phenotypic characterization of patients with COPD may have potential
prognostic and therapeutic implications. Available information on the
relationship between emphysema and the clinical presentation in patients with
COPD is limited to advanced stages of the disease. The objective of this study
was to describe emphysema presence, severity, and distribution and its impact on
clinical presentation of patients with mild to moderate COPD. METHODS: One
hundred fifteen patients with COPD underwent clinical and chest CT scan
evaluation for the presence, severity, and distribution of emphysema. Patients
with and without emphysema and with different forms of emphysema distribution
(upper/lower/core/peel) were compared. The impact of emphysema severity and
distribution on clinical presentation was determined. RESULTS: Fifty percent of
the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%).
Upper and core zones had the more severe degree of emphysema. Patients with
emphysema were older, more frequently men, and had lower FEV(1)%, higher total
lung capacity percentage, and lower diffusing capacity of the lung for carbon
monoxide. No differences were found between the clinical or physiologic
parameters of the different emphysema distributions. CONCLUSIONS: In patients
with mild to moderate COPD, although the presence of emphysema has an impact on
physiologic presentation, its severity and distribution seem to have little
impact on clinical presentation
Unravelling the skills and motivations of Magdalenian artists in the depths of Atxurra Cave (Northern Spain)
Atxurra cave has a decorated assemblage composed of more than a hundred engraved animal depictions. All of them are located in deep parts of the cave and most of them are hidden in raised areas, away from the main path. The main sector is the “Ledge of the Horses”, located at 330 m from the entrance of the cave. It is a space of 12 m long and 1.5 m wide, elevated 4 m above the cave floor. This area includes almost fifty engraved and painted animals accompanied by a dozen flint tools, three fireplaces, and around one hundred charcoal fragments from torches. This extraordinary archaeological record allows us to value the complexity of the artistic production inside the caves during the Upper Palaeolithic. Our study has confirmed that there is planning prior to artistic production, both in terms of the iconographic aspects (themes, techniques, formats), its location (visibility, capacity), and the lighting systems. Furthermore, the data indicates the panel was decorated to be seen by third parties from different positions and was expressly illuminated for this purpose. This evidence supports the role of rock art as a visual communication system in Upper Palaeolithic societies.The authors wish to thank the Cultural Heritage Service of the Diputación Foral de Bizkaia for funding the 4-year multidisciplinary study project (2016–2020) “Study of rock art in Atxurra cave” directed by Dr Diego Garate. The present study has been carried out within the framework of the research project "Before art: social investment in symbolic expressions during the Upper Palaeolithic in the Iberian Peninsula” (PID2019-107262GB-I00), PI: Diego Garate, funded by the Ministerio de Ciencia, Innovación y Universidades (Spain), the research projet “Scientific virtual reality for the study and dissemination of the scenarios of artistic creation in Palaeolithic caves (RealCaveART)” (PDC2022-133124-I00), PI: Diego Garate, funded by MCIN/AEI/10.13039/501100011033 and the European Union Next Generation EU/PRTR, and the research project “Creation and perception in Anatomically Modern Humans: analysis of the biological, cognitive and social skills linked to the production of Paleolithic art (ArtMindHuman)” (PID2021-125166OB-I00), PI: Olivia Rivero, funded by the Ministerio de Ciencia, Innovación y Universidades (Spain). I. Intxaurbe’s PhD research is funded by a grant for the training of research personnel (PIF 2019) at the University of the Basque Country (UPV/EHU). M.A. Median-Alcaide developpes lighting system analyses inside the framework of her “A-Light” project of the HORIZON-MSCA-2021-PF-01-01 (101066376)
Epicardial adipose tissue in patients with chronic obstructive pulmonary disease
EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular event
Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies
IntroductionOn March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. ObjectiveTo conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. ResultsAutonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. ConclusionSymptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease
Pathogenic variants of DNAJC12 and evaluation of the encoded cochaperone as a genetic modifier of hyperphenylalaninemia
This is the peer reviewed version of the following article: Pathogenic variants of DNAJC12 and evaluation of the encoded cochaperone as a genetic modifier of hyperphenylalaninemia. Human Mutation (2020): 25 April, which has been published in final form at [https://doi.org/10.1002/humu.24026. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsThe variants identified in this study are openly available at http://www.lovd.nl/ with reference numbers 0000644164, 0000645396, 0000644166, and 0000405673Biallelic variants of the gene DNAJC12, which encodes a cochaperone, were recently described in patients with hyperphenylalaninemia (HPA). This paper reports the retrospective genetic analysis of a cohort of unsolved cases of HPA. Biallelic variants of DNAJC12 were identified in 20 patients (generally neurologically asymptomatic) previously diagnosed with phenylalanine hydroxylase (PAH) deficiency (phenylketonuria [PKU]). Further, mutations of DNAJC12 were identified in four carriers of a pathogenic variant of PAH. The genetic spectrum of DNAJC12 in the present patients included four new variants, two intronic changes c.298‐2A>C and c.502+1G>C, presumably affecting the splicing process, and two exonic changes c.309G>T (p.Trp103Cys) and c.524G>A (p.Trp175Ter), classified as variants of unknown clinical significance (VUS). The variant p.Trp175Ter was detected in 83% of the mutant alleles, with 14 cases homozygous, and was present in 0.3% of a Spanish control population. Functional analysis indicated a significant reduction in PAH and its activity, reduced tyrosine hydroxylase stability, but no effect on tryptophan hydroxylase 2 stability, classifying the two VUS as pathogenic variants. Additionally, the effect of the overexpression of DNAJC12 on some destabilizing PAH mutations was examined and a mutation‐specific effect on stabilization was detected suggesting that the proteostasis network could be a genetic modifier of PAH deficiency and a potential target for developing mutation‐specific treatments for PKUThis work was funded by grant PI16/00573, B2017/BMD-3721, the Fundación Isabel Gemio and the Fundación La Caixa (LCF/PR/PR16/11110018), an institutional grant from the Fundación Ramón Areces to the Centro de Biología Molecular Severo Ochoa, and the European Regional Development Fun