Ideación autolítica al final de la vida en pacientes oncológicos paliativos: a propósito de un caso

La enfermedad oncológica avanzada produce en los enfermos una serie de síntomas frecuentemente invalidantes y molestos que pueden provocar gran malestar psicológico tanto en el paciente como en la familia. En este contexto, incluso a pesar de un aceptable control sintomático, los pacientes pueden presentar ideación autolítica. Esta situación es de gran complejidad y de difícil manejo tanto para la familia como para el equipo sanitario asistencial, donde cuestiones éticas, morales, espirituales religiosas y legales confluyen. Los aspectos referidos pueden ser complementarios pero otros no, pudiendo, de esta manera, quebrantar el principio de autonomía del paciente en la medida que los deseos personales del mismo pueden comprometer el plan de actuación del equipo sanitario que le atiende. En este artículo, se expone la experiencia vivida en nuestro servicio ante un paciente con ideas francas de suicidio y las actuaciones que se llevaron a cabo, así como las reflexiones que esta situación generó. Finalmente, se proponen algunas recomendaciones consensuadas con juristas y expertos en Bioética

Laforin, a dual specificity protein phosphatase involved in Lafora disease, is phosphorylated at Ser25 by AMP-activated protein kinase

Carlos Romá-Mateo et alt.Lafora progressive myoclonus epilepsy [LD (Lafora disease)] is a fatal autosomal recessive neurodegenerative disorder caused by loss-of-function mutations in either the EPM2A gene, encoding the dual-specificity phosphatase laforin, or the EPM2B gene, encoding the E3-ubiquitin ligase malin. Previously, we and others showed that laforin and malin form a functional complex that regulates multiple aspects of glycogen metabolism, and that the interaction between laforin and malin is enhanced by conditions activating AMPK (AMP-activated protein kinase). In the present study, we demonstrate that laforin is a phosphoprotein, as indicated by two-dimensional electrophoresis, and we identify Ser25 as the residue involved in this modification. We also show that Ser25 is phosphorylated both in vitro and in vivo by AMPK. Lastly, we demonstrate that this residue plays a critical role for both the phosphatase activity and the ability of laforin to interact with itself and with previously established binding partners. The results of the present study suggest that phosphorylation of laforin-Ser25 by AMPK provides a mechanism to modulate the interaction between laforin and malin. Regulation of this complex is necessary to maintain normal glycogen metabolism. Importantly, Ser25 is mutated in some LD patients (S25P), and our results begin to elucidate the mechanism of disease in these patientsThis work was supported the Spanish Ministry of Education and Science [grant number SAF2008-01907 (to P.S.)]; the Generalitat Valenciana [grant number Prometeo 2009/051 (to P.S.)]; the National Institutes of Health [grant numbers R00NS061803, P20RR020171, R01NS070899 (to M.S.G.)]; and the University of Kentucky College of Medicine startup funds (to M.S.G.)Peer reviewe

Ideación autolítica al final de la vida en pacientes oncológicos paliativos: a propósito de un caso

La enfermedad oncológica avanzada produce en los enfermos una serie de síntomas frecuentemente invalidantes y molestos que pueden provocar gran malestar psicológico tanto en el paciente como en la familia. En este contexto, incluso a pesar de un aceptable control sintomático, los pacientes pueden presentar ideación autolítica. Esta situación es de gran complejidad y de difícil manejo tanto para la familia como para el equipo sanitario asistencial, donde cuestiones éticas, morales, espirituales religiosas y legales confluyen. Los aspectos referidos pueden ser complementarios pero otros no, pudiendo, de esta manera, quebrantar el principio de autonomía del paciente en la medida que los deseos personales del mismo pueden comprometer el plan de actuación del equipo sanitario que le atiende. En este artículo, se expone la experiencia vivida en nuestro servicio ante un paciente con ideas francas de suicidio y las actuaciones que se llevaron a cabo, así como las reflexiones que esta situación generó. Finalmente, se proponen algunas recomendaciones consensuadas con juristas y expertos en Bioética

Use of the Ultrasound Technique as Compared to the Standard Technique for the Improvement of Venous Cannulation in Patients with Difficult Access

(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case–control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model Insyte™ Autoguard™ with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels.Enfermerí

Prevalent Technique and Results of Hemorrhoidal Embolization

Hemorrhoids are blood cushions located in the anus and lower rectum, acknowledged as a common cause of bleeding, which can reduce quality of life. The development of minimally invasive techniques such as endovascular embolization of superior rectal artery, “Emborrhoid technique”, is an effective treatment, with no pain or ischemic complications, and allows quick patient recovery. Our purpose is to describe the general technique and discuss the results of the current literature

Ideación autolítica al final de la vida en pacientes oncológicos paliativos : a propósito de un caso

La enfermedad oncológica avanzada produce en los enfermos una serie de síntomas frecuentemente invalidantes y molestos que pueden provocar gran malestar psicológico tanto en el paciente como en la familia. En este contexto, incluso a pesar de un aceptable control sintomático, los pacientes pueden presentar ideación autolítica. Esta situación es de gran complejidad y de difícil manejo tanto para la familia como para el equipo sanitario asistencial, donde cuestiones éticas, morales, espirituales religiosas y legales confluyen. Los aspectos referidos pueden ser complementarios pero otros no, pudiendo, de esta manera, quebrantar el principio de autonomía del paciente en la medida que los deseos personales del mismo pueden comprometer el plan de actuación del equipo sanitario que le atiende. En este artículo, se expone la experiencia vivida en nuestro servicio ante un paciente con ideas francas de suicidio y las actuaciones que se llevaron a cabo, así como las reflexiones que esta situación generó. Finalmente, se proponen algunas recomendaciones consensuadas con juristas y expertos en BioéticaThe development of the illness in oncology patients produces a series of uncomfortable and frequently annoying symptoms that can cause significant psychological distress in both patients and their relatives. Under these circumstances, the patients can experience autolytic ideation, even when acceptable symptomatic controls are in place. This situation is of great complexity and of difficult handling both for the family and for the medical care team as they have to deal with various ethical, moral, spiritual and legal questions. These aspects can be complementary to existing ones, but others will not be. This situation can conflict with the principle of autonomy of the patient, in the sense that his/her personal desires may compromise or even jeopardize the action plan of the medical team that looks after the patient. In this clinical note, we share the experience lived in our service regarding a patient with the idea of committing suicide and the actions that were carried out. Finally, some recommendations agreed with lawyers and experts in Bioethics are suggeste

Use of the Ultrasound Technique as Compared to the Standard Technique for the Improvement of Venous Cannulation in Patients with Difficult Access

(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case–control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model InsyteTM AutoguardTM with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels.Sin financiación2.645 JCR (2020) Q2, 40/88 Health Policy & Services0.533 SJR (2021) Q2, 115/273 Health PolicyNo data IDR 2020UE

Deciphering the role of vaginal and sperm metagenome in the success of artificial insemination in sheep

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Regulation of glycogen synthesis by the laforin-malin complex is modulated by the AMP-activated protein kinase pathway

12 páginas, 8 figuras -- PAGS nros. 667-678Lafora progressive myoclonus epilepsy (LD) is a fatal autosomal recessive neurodegenerative disorder characterized by the presence of glycogen-like intracellular inclusions called Lafora bodies. LD is caused by mutations in two genes, EPM2A and EPM2B, encoding respectively laforin, a dual-specificity protein phosphatase, and malin, an E3 ubiquitin ligase. Previously, we and others have suggested that the interactions between laforin and PTG (a regulatory subunit of type 1 protein phosphatase) and between laforin and malin are critical in the pathogenesis of LD. Here, we show that the laforin–malin complex downregulates PTG-induced glycogen synthesis in FTO2B hepatoma cells through a mechanism involving ubiquitination and degradation of PTG. Furthermore, we demonstrate that the interaction between laforin and malin is a regulated process that is modulated by the AMP-activated protein kinase (AMPK). These findings provide further insights into the critical role of the laforin–malin complex in the control of glycogen metabolism and unravel a novel link between the energy sensor AMPK and glycogen metabolism. These data advance our understanding of the functional role of laforin and malin, which hopefully will facilitate the development of appropriate LD therapiesThis work was supported by grants from Fundación La Caixa, Fundación Marato TV3, the Spanish Ministry of Education and Science (SAF2005-00852; SAF2005-00913, BFU2005-00087), the Instituto de Salud Carlos III (CIBER-ER) and the European Commission (LSHM-CT-2004-005272)Peer reviewe