Safety of continuous propofol sedation for endoscopic procedures in elderly patients

OBJECTIVE

to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population.

MATERIAL AND METHODS

patients who received endoscopist-directed propofol sedation were classified into two groups according to age. Group I: > 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep sedation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded.

RESULTS

one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%, Group II: 14%; p:n.s.). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation.

CONCLUSIONS

continuous propofol sedation during endoscopic procedures in elderly patients > 80 years is as safe as in younger patients.

Preliminary study of emotion recognition using facial affect cards of the training of affect recognition program (TAR) in Spanish population

Introduction

Social cognition is presently an important focus in rehabilitation of patients wish schizophrenic psychoses. Emotion recognition in one of its different components, the Training of Affect Recognition (TAR) is a therapy program specifically developed aiming at improving affect recognition.

Objectives

To test if the material of the TAR program in terms a series of facial affect cards is reliable for emotion recognition in a Spanish control population.

Methods

A sample of Spanish control subjects were shown the TAR's series of facial affect cards. It includes the following emotions: happiness, sadness, surprise, fear, angry and disgust, and the neutral facial affect. Reliability was assessed by means of the kappa coefficient. Kappa values higher than 0.4 were considered reliable, the following criterion was accepted: kappa values < 0.4, low reliability; 0.4 to 0.75, moderate reliability; > 0.76, strong reliability.

Results

The sample was formed by subjects from the general population with no previous history of psychiatric disorders (n = 20). The following kappa values were obtained: happiness, 0.8406 (CI 0.7744–0.9068), sadness, 0.6171 (CI 0.5377–0.6964), surprise, 0.6582 (CI 0.5859–0.7304), fear, 0.4509 (CI 0.3569–0.5448), angry, 0.6252 (CI 0.5464–0.7040), disgust, 0.7700 (CI 0.6943–0.8456), neutral, 0.5534 (CI 0.4663–0.6404).

Conclusions

In a preliminary study in a sample of 20 Spanish control subjects using the TAR's series of facial affect cards, the six basic emotions and the neutral facial affect were recognized with at least a moderate reliability. A strong reliability was obtained in happiness and disgust, and a moderate reliability in surprise, angry, sadness, neutral, fear.

Multiple sclerosis and solar exposure before the age of 15 years: case-control study in Cuba, Martinique and Sicily

Few studies report a protective role of childhood solar exposure to multiple sclerosis. Our objective was to confirm the protective role of childhood solar exposure in multiple sclerosis in Cuba, Martinique and Sicily. This was a matched case- control study, and cases met Poser criteria for clinically, laboratory (definite, probable) multiple sclerosis. Controls were resident population, without neurological disorder, living close to cases (within 100 km), matched for sex, age (+/-5 years), residence before age 15. We recruited 551 subjects during a 1-year period (193 cases, Cuba n = 95, Sicily n = 50, Martinique n = 48; 358 controls). Some (89%) met definite clinical multiple sclerosis criteria (relapsing remitting form (with and without sequel) (74%), secondary progressive (21%), primary progressive (5%)). Odds ratios in a uni-variate analysis were: family history of multiple sclerosis (5.1) and autoimmune disorder (4.0); wearing shirt (3.5), hat (2.7), pants (2.4); sun exposure causing sunburn (1.8); sun exposure duration (1 h more/day; weekends 0.91, weekdays 0.86); bare-chested (0.6); water sports (0.2). Independent factors in the multivariate analysis were family history of multiple sclerosis (4.8 (1.50-15.10)), wearing pants under sunlight (1.9 (1.10-3.20)), sun exposure duration (1 h more/ day, weekdays 0.90 (0.85-0.98), weekends 0.93 (0.87-0.99)), water sports (0.23 (0.13-0.40)). We conclude that outdoor leisure activities in addition to sun exposure reports are associated with a reduced multiple sclerosis risk, with evidence of dose response.

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proc

INTRODUCTION

There are two kinds of actinic proctitis--one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. The incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors.

OBJECTIVE

To evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis.

MATERIAL AND METHOD

A retrospective search of patients with the diagnosis of actinic proctitis. The number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed.

RESULTS

We found 22 patients with a diagnosis of actinic proctitis. Nineteen were males (86.7%) and three (13.6%) were females. Nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). The mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions.

CONCLUSION

Multiple treatments are described in the literature. None of them have shown promising results. Our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile.

[Obtain best usage of meropenem dose in severe infections. Results of an observational multicenter study]

OBJECTIVE

To describe the effectiveness and tolerability of the dose adjustment of meropenem in empirical treatment of nosocomial infections in critically-ill patients admitted to intensive care medicine services.

METHODS

Prospective, observational and multicenter study in patients admitted to 17 intensive care medicine services with nosocomial infection, who were initially treated with meropenem, 1 g every 8 h, were eligible. The initial dose was adjusted to 0.5 g every 8 h if there were: a) a favorable clinical course, and b) microbiological isolation of meropenem-susceptible pathogens or absence of pathogens in cultures.

RESULTS

Ninety-two patients in whom meropenem doses were adjusted to 0.5 g every 8 h were included. Ventilator-associated pneumonia followed by bacteremia was the most frequently treated infections. Microbiological studies were positive in 53 patients, with a predominance of gram-positive bacteria (53.7%), especially methicillin-susceptible Staphylococcus aureus, followed by gram-negative bacteria (42.7 %). A total of 18 patients were not evaluable at the end of treatment. Sixty-seven (90.5 %) of the 74 evaluable patients had a favorable clinical course (54 patients cured and 13 improved). In 50 out of 53 microbiologically evaluable cases, eradication or apparent eradication of initial microorganisms was achieved. In 3 cases, the initial pathogen persisted: Acinetobacter baumannii (2 cases) and Pseudomonas aeruginosa (1 case). On three occasions, new pathogens developed during treatment: A. baumannii (2 cases) and methicillin-resistant S. aureus (1 case). Adverse events occurred in 3 patients (4%), none of which was considered severe, and withdrawal of meropenem was not necessary. A total of 25 (27.2 %) patients died, three of them in relation to the infectious process.

CONCLUSIONS

Dose adjustment of meropenem to 0.5 g every 8 h is a useful tool in the treatment of severe nosocomial infections in patients admitted to services of intensive care medicine except in cases in which causative pathogens are non-fermenting Gram-negative bacteria.

Impact of millennial mining activities on sediments and microfauna of the Tinto River estuary (SW Spain)

In this paper, we analyze two short cores collected in the Tinto estuary (SW Spain), and describe the palaeoenvironmental evolution of this area during the last two millennia, along with the influence of historical mining activities and recent industrial pollution on sediments and microfauna (foraminifera and ostracoda). Although there were no significant changes in the distribution of microorganisms, a first pollution period (0-150 AD) was recorded in high sediment pollution by Cu in the shallow palaeochannels of the middle estuary. During this period and the following 1700 years, tolerant pioneer species of both foraminifera and ostracoda were found predominantly in the inner, protected areas of the estuary, while the bottom sediments were subjected to high hydrodynamic gradients, and consequently showed lower density and diversity of organisms. In the last 150 years, acid mine drainage processes, introduction of a new mining period, and the polluted inputs derived from two industrial processes resulted in increased heavy metal contamination of the bottom sediments, and corresponding extirpation of ostracodes and restriction of foraminifers to the inner zones of the estuary.

Relation of simple clotting tests to clotting factor levels in liver disease

The prothrombin time with Manchester and ox thromboplastins, the 'P & P' test of Owren and Aas, the partial thromboplastin time, the thrombin time and assays for factors II, V, VII, VIII:C, IX and X were performed by one observer in 18 patients with liver disease and 27 normal subjects; the prothrombin time and partial thromboplastin time were also carried out on another 28 similar patients by various observers. Routine liver function tests were measured in all patients. The prothrombin time with Manchester thromboplastin was well correlated with other clotting tests, and performing the other tests did not add to the information. Discriminant function analysis confirmed that clotting tests did not distinguish between different types of liver disease. Correlations between clotting tests and liver function tests reflected liver cell damage but were also influenced by acute phase reactions.

Selection of young soccer players in terms of anthropometric and physiological factors

AIM

The aim of this paper was to describe the anthropometric and physiological characteristics of young soccer players (14-17 years old) which were associated with their being successful or not as soccer players.

METHODS

Somatotype and body composition was calculated by measuring skinfolds, limb circumferences and joint diameters. VO(2max) was estimated by the Astrand's Test. Sprint, jump and endurance tests were also performed.

RESULTS

The most relevant differences were obtained between selected and non-selected players belonging to the 14-year-old team. Selected players were taller, heavier, leaner and faster and they had higher absolute or relative VO(2max). In addition, a higher % of selected players was found among those born during the first 6 months of the year. In the rest of the teams, the agility was better in selected than in non-selected players. At later ages, there was also a predominance of players born during the first 6 months of the year.

CONCLUSIONS

These results indicate that around the time of puberty, parameters associated with physical maturity such as height, size, speed, VO(2max), or chronological age are important to determine the success of a soccer player. At older ages, other factors such as agility seem to be more important. Nevertheless, players born in the 1st semester of the year are also more frequent in the older teams. These findings should be taken into account by trainers and coaches, in order to avoid biasing their selection choices.

The present environmental scenario of the Nador Lagoon (Morocco)

In this paper, we present a multivariate approach (waters, sediments, microfauna) concerning the environmental state of the Nador Lagoon (NE Morocco). The normal water quality parameters (salinity, pH, nutrients) of the dominant marine flows are altered by local fecal water effluents, urban discharges, sewages derived from a water treatment station, and residues originated in a slaughterhouse. The geochemical analyses carried out in surficial sediment samples show very high concentrations of all metals studied near an old iron mine and moderate contents between Nador and its treatment station. Ostracods are good bioindicators of these environmental impacts, with the presence of a highly brackish assemblage in the quieter, more confined areas or the appearance of opportunistic species under hypoxic conditions. In addition, these microcrustaceans are absent in polluted bottom sediments or areas with high hydrodynamic gradients, whereas they decrease in both density and diversity if the subaerial exposure increases.