The Roma population's fear of donating their own organs for transplantation

BACKGROUND

The refusal rate for donating organs among the Roma people is much higher than that of any other social group.

OBJECTIVE

To analyze the attitude towards the donation of one's own organs among the Roma population living in Spain.

METHOD

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TYPE OF STUDY

Spanish national observational sociological study stratified by gender and age.

STUDY POPULATION

Roma population aged ≥15 years living in Spain.

SAMPLE SIZE

1,253 respondents. Assessment instrument: Validated questionnaire on attitude towards organ donation for transplantation "PCID - DTO Ríos". Field work: Random selection based on stratification. Anonymous and self-administered completion. The collaboration of people of Roma ethnicity was required.

STATISTICS

Student's t test, χ², Fisher's exact test and a logistic regression analysis.

RESULTS

The degree of completion was 18.2% (n = 228). Of those who completed the questionnaire, 42.1% (n = 96) were in favor of donation, 30.3% (n = 69) were undecided and the remaining 27.6% (n = 63) were against it. Of the 1,025 (81.8%) who declined to complete the questionnaire, 1,004 (98%) indicated that it was for fear of speaking about and filling in a questionnaire that raises the issue of death and organ donation after death. If those who did not complete the questionnaire due to fear of death and donating organs after death are considered not in favor, the results would be as follows: 7.8% (n = 96) in favor of donating their organs compared to 92.2% (n = 1166) not in favor (against or undecided).

CONCLUSIONS

A majority of the Roma population prefer not speak of death nor organ donation after death. These findings show that current campaigns to promote organ donation are not effective in this population group.

[Evaluation of the telematic consultation in endocrine surgery during confinement due to COVID-19]

BACKGROUND

The coronavirus disease pandemic of 2019 (COVID-19) made necessary to remodel the hospital's clinical consultations.

OBJECTIVE

To evaluate the telematic consultation in endocrine surgery, as well as to select the group of patients susceptible to perform a telematic consultation in the future according to this assessment.

METHODS

The study population were patients who had a clinical consultation by telephone. The evaluation was made with the Net Promoter Score (NPS).

STATISTICAL ANALYSIS

SPSS v.28, X² test and a multivariate analysis.

RESULTS

55 patients were analyzed. The NPS was +16, 24 promoters (43.6%) and 15 detractors (27.2%). There were differences between those whose main reason for consultation was malignant pathology (OR 4.5; p = 0.033). The NPS between malignant vs. non-malignant pathology was -13 vs. +38 (p > 0.001). The evaluation of the telematic consultations for the future was: telephone (83% very well), video call (58%), videoconference (19%).

CONCLUSIONS

The evaluation of the telephone consultation has been good, finding a better assessment among patients with non-malignant pathology. Its future implementation could be necessary, being the telephone the preferred way.

Antineoplastic agents exacerbating Charcot Marie Tooth disease: red flags to avoid permanent disability

BACKGROUND

Charcot Marie Tooth (CMT) disease is the most common form of hereditary neuropathy. Due to the high prevalence of mild and undiagnosed forms, patients with CMT disease may be exposed to severe neurotoxicity following the administration of neurotoxic chemotherapies. The aim of this report is to alert oncologists to the potential to precipitate severe irreversible peripheral neuropathies when administering neurotoxic compounds to undiagnosed CMT patients.

MATERIAL AND METHODS

A retrospective research in the OncoNeuroTox database was performed (2010-2016), searching for patients with the diagnosis of chemotherapy-induced peripheral neuropathy (CIPN) and CMT disease. A comprehensive literature review for previously published cases was performed using the Pubmed and Cochrane databases (1972-2017).

RESULTS

Among 428 patients with CIPN, we identified eight patients with concomitant CMT disease. Seven patients out of the eight had no previous diagnosis of CMT disease, although accurate familial history disclosed mild signs of peripheral neuropathy in five cases. Patients themselves had minor stigmata of long-standing peripheral damage. Patients received chemotherapy regimens based on vinca alkaloids, taxanes or a combination of vinca alkaloids and platinum compounds. In two cases, cumulative doses were below or equal to the expected neurotoxic threshold. Following chemotherapy administration, patients developed severe length-dependent sensory-motor deficits. Despite early drug discontinuation, most patients remained severely disabled.

CONCLUSION

A brief checklist to disclose long-standing signs of peripheral neuropathy could be helpful to detect patients with undiagnosed hereditary neuropathies who could be at risk of developing severe irreversible neurotoxicity following the administration of neurotoxic agents.

[Algorithm for an etiological classification of prematurity]

The etiology of preterm birth is difficult to classify. It is usually divided into three clinical types according to its clinical presentation: medically indicated; caused by ruptured membranes; and spontaneous or idiopathic. However, this classification is controversial, imprecise and can result in multiple interpretations when applied.

OBJECTIVE

To design an etiologically based classification of preterm birth, and to design a system to easily assign each case during the perinatal period.

METHODS

Review of literature, qualitative analysis using consensus methods through nominal group technique, and quantitative analysis of a pilot study using a first version of the algorithm.

RESULTS

A classification is made to establish a general division between the "primary cause" and "associated causes" of preterm birth, that allows remote causes or risk factors to be included. The primary cause includes seven categories: inflammatory (ruptured membranes and related); vascular (intrauterine growth restriction and related); maternal-local; maternal-systemic; fetal pathology; fetal distress; idiopathic. The medically indicated preterm birth is defined as a previous or independent category and so is compatible with the other, previously mentioned causes . An algorithm was designed to make it easier to classify the primary cause of preterm birth using a flowchart.

CONCLUSIONS

A pragmatic classification of preterm birth is proposed that may help to achieve better precision and agreement between clinicians.

Reducing errors in the management of hyperbilirubinaemia: validating a software application

OBJECTIVE

To verify the usefulness and reliability of a software tool we developed to help to apply the American Academy of Pediatrics (AAP) Guidelines 2004 on hyperbilirubinaemia according to the infant's age in hours and their clinical risk factors.

DESIGN

Randomised, cross-over, controlled trial with 20 simulated clinical cases comparing the "manual" application of the guidelines with our software application.

PARTICIPANTS

Fifteen doctors (eight final-year residents and seven consultants) from two hospitals in Spain.

MAIN OUTCOME MEASURES

Major errors (defined a priori as any deviation from the AAP guidelines that involve a risk of morbidity or mortality for the patient), minor errors (those that cause discomfort and/or, in extremely rare cases, morbidity) and time spent.

RESULTS

Fifteen doctors each managed 20 simulated cases, half by using the guidelines alone and half using the software tool. Without the software application, 42 "minor" errors were made. With it, only 25 errors were made. "Major" errors also decreased from 10 to 2 with the software. As a group, the residents benefited most; they made an average of 1.8 errors fewer per 10 cases. Use of the software reduced the time taken by the residents to resolve the cases, although the mean reduction in time was not significant for the group of consultants.

CONCLUSIONS

The use of simulated clinical cases revealed many errors in the routine management of hyperbilirubinaemia. The software helped clinicians make fewer errors and saved time for residents, but not consultants.

A reversed-phase ion-interaction chromatographic method for in-vitro estimation of the percutaneous absorption of water-soluble UV filters

An analytical method based on ion-interaction chromatography with UV detection for simultaneous in-vitro estimation of the percutaneous absorption of the most used water-soluble UV filters in sunscreen cosmetics is proposed. These UV filters were phenylbenzimidazole sulfonic acid, disodium phenyl dibenzimidazole tetrasulfonate, benzophenone-4, and terephthalylidene dicamphor sulfonic acid. The methodology is based on applying the sunscreen containing the target UV filters to human epidermis in a diffusion cell. Analytes are determined in the receptor solution. To ensure skin integrity, screening of the cells was carried out by analytical determination of a marker. Analytical variables such as percentage ethanol, concentration of ion-pairing agent, pH of the mobile phase, and temperature were studied in order to achieve high resolution of the chromatographic peaks in the lowest possible time of analysis. The conditions selected consisted of a mobile phase composed of 35:65 (v/v) ethanol-ammonium acetate buffer solution (pH 4, containing 50 mmol L(-1) tetra-n-butylammonium bromide). The chromatographic determination was carried out with the analytical column at 50 degrees C. UV detection was carried out at the maximum absorption wavelength for each analyte. The limit of detection (3s(y/x)/b) ranged from 16 to 65 ng mL(-1), depending on the analyte.

Infant position in neonates receiving mechanical ventilation

BACKGROUND

Several body positions other than standard supine position have been used in patients undergoing intensive care for reducing the incidence of pressure ulcers of the skin, contractures or ankylosis and for improving the patient's well being. In patients from different age groups undergoing mechanical ventilation (MV), it has been observed that particular positions, such as prone position, may improve some respiratory parameters. Benefits from these positions have not been clearly defined in critically ill newborns who may require mechanical ventilation for extended periods of time.

OBJECTIVES

To assess the effects of different positioning of newborn infants receiving MV on short term respiratory outcomes and complications of prematurity.

SEARCH STRATEGY

Databases searched (up to May 2006) were the Oxford Database of Perinatal Trials, CINAHL, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2006). Hand searches of proceedings of the Society for Pediatric Research from 1990 to May 2006 were used to identify unpublished studies.

SELECTION CRITERIA

Randomised or quasi randomised clinical trials comparing different positions in newborns receiving mechanical ventilation.

DATA COLLECTION AND ANALYSIS

Three independent and unblinded reviewers assessed the trials for inclusion in the review and extracted the data. Data were double-checked and entered into the Review Manager software.

MAIN RESULTS

Eleven trials involving 206 infants were included in this review. Several positions were compared: prone vs. supine, prone vs. lateral right, lateral right vs. supine, lateral left vs. supine, lateral right vs. lateral left and good lung dependent vs. good lung uppermost. Apart from one of the two studies that compared lateral right vs. lateral left positions, and one comparing prone vs. supine position, all the included studies had a crossover design. Comparing prone vs. supine position, an increase in arterial P02 in the prone position of between 2.75 and 9.72 mm Hg (95% CI) was observed (one trial). When % hemoglobin oxygen saturation was measured with pulse oximetry, improvement in the prone position was from 1.18 to 4.36% (typical effect based on four trials). In addition, there was a slight improvement in the number of episodes of desaturation. It was not possible to establish whether this effect remained once the intervention was stopped. Negative effects from the interventions were not described, although this issue was not studied in sufficient detail. Effects of position on other outcomes were not statistically significant; however, either positive nor negative effects cannot be excluded considering the small numbers that were studied.

AUTHORS' CONCLUSIONS

The prone position was found to slightly improve the oxygenation in neonates undergoing mechanical ventilation. However, we found no evidence concerning whether particular body positions during mechanical ventilation of the neonate are effective in producing sustained and clinically relevant improvements.

A liquid chromatography–fluorimetric method for the in vitro estimation of the skin penetration of disodium phenyldibenzimidazole tetrasulfonate from sunscreen formulations through human skin

Disodium phenyldibenzimidazole tetrasulfonate (PDT) is a new organic UV filter with hydrophilic properties used in modern sunscreen spray formulations. The aim of this work was to develop and validate an analytical method that can be used to study skin absorption of PDT from sunscreens. Results obtained in vitro for human skin showed a low level of absorption. The proposed in vitro method employs a diffusion cell. Sunscreen lotion was applied onto pretreated human skin, which was then placed in the cell. PDT was collected in a receptor liquid, the surface of which was in contact with the skin. The solutions obtained were diluted appropriately and analyzed by liquid chromatography without any interference. The analytical features of chromatographic determination with fluorimetic detection were suited to this analytical problem, since this method gave a limit of detection of 1 ng ml(-1). Phenol red (PR) was used as a marker to check the skin integrity, and a sensitive method based on sequential injection on-line solid-phase extraction coupled with spectrophotometric detection was developed for determining this marker in the receptor liquid in order to screen the cells.

Sequential-injection determination of traces of disodium phenyl dibenzimidazole tetrasulphonate in urine from users of sunscreens by on-line solid-phase extraction coupled with a fluorimetric detector

A sensitive and selective method to determine disodium phenyl dibenzimidazole tetrasulphonate (PDT) in the urine of sunscreen users, which is suitable for studies on body accumulation/excretion is proposed. On-line solid-phase extraction allows the analyte to be retained and subsequentely eluted, using a strong anion exchange (SAX) microcolumn. Standard addition calibration was carried out with only one standard. The wavelengths of excitation and emission were 330 and 454 nm, respectively. The method allows PDT to be determined in both, spiked and unspiked human urine samples, without any pre-treatment. Results obtained for spiked urine samples (40-200 ng ml(-1)) showed the accuracy of the method. The mean relative standard deviations (R.S.D.) of the results was 7%. Five volunteers applied a sunscreen lotion containing 5% PDT and their urinary excretion was controlled from the moment of application until the excreted amounts were no longer detectable. The sensitivity of the proposed method is in the order of 1900 ml microg(-1) and the detection limit (3S(y/x)/b) is in the order of 5 ng of PDT, which means 10 ng ml(-1) for a 500 microl injected volume, and this is suitable for the PDT levels found in the urine.

Chilaiditi syndrome associated with transverse colon volvulus: first report in a paediatric patient and review of the literature

A hepatodiaphragmatic interposition of the colon, known as Chilaiditi's sign, is usually discovered by chance during the study of another event, given that its presentation is normally asymptomatic. When this finding is accompanied by clinical symptoms, either intermittent or persistent, it is known as Chilaiditi syndrome. It may be associated with intestinal obstruction due to twisting. The association of Chilaiditi syndrome and transverse colon volvulus is exceptional. To date only three cases have been reported, all in adult males. Among the common predisposing factors were anatomical alterations of the intestine such as elongation of the colon and a history of prior abdominal surgery. The clinical symptoms were due to the intestinal obstruction. We present the first description in the paediatric population of an association of transverse colon volvulus and Chilaiditi syndrome whose predisposing factors, clinical symptoms and treatment differed from those reported in the non-paediatric cases published to date.

Infant position in neonates receiving mechanical ventilation

BACKGROUND

Several body positions other than standard supine position have been used in patients undergoing intensive care for reducing the incidence of pressure ulcers of the skin, contractures or ankylosis and for improving the patient's well being. In patients from different age groups undergoing mechanical ventilation (MV), it has been observed that particular positions such as prone position may improve some respiratory parameters. Benefits from these positions have not been clearly defined in Neonatology, a field where it is common that patients require mechanical ventilation sometimes during extended time periods.

OBJECTIVES

To assess the effects on both short and long-term outcomes of different positioning of newborn infants receiving MV.

SEARCH STRATEGY

Databases searched (up to January 2002) were the Oxford Database of Perinatal Trials, CINAHL, MEDLINE, EMBASE and Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002). Hand searches of proceedings of the Society for Pediatric Research from 1990 to January 2002 were used to identify unpublished studies.

SELECTION CRITERIA

Randomised or quasi randomised clinical trials comparing different positions in newborns receiving mechanical ventilation.

DATA COLLECTION AND ANALYSIS

Three independent and unblinded reviewers assessed the trials for inclusion in the review and extracted the data. Data were double-checked and entered into the Review Manager software.

MAIN RESULTS

Ten trials involving 164 infants were included in this review. Several positions were compared: prone vs. supine, prone vs. lateral right, lateral right vs. supine, lateral left vs. supine, lateral right vs. lateral left and good lung dependent vs. good lung uppermost. Apart from one of the two studies that compared lateral right vs. lateral left positions, all the included studies had a crossover design. Comparing prone vs. supine position, an increase in arterial P02 in the prone position of between 2.75 and 9.72 mm Hg (95%CI) was observed (one trial). When % hemoglobin oxygen saturation was measured with pulse oximetry, improvement in the prone position was from 1.17 to 4.36% (typical effect based on four trials). It was not possible to establish whether this effect remained once the intervention was stopped. Negative effects from the interventions were not described, although this issue was not studied enough. Effects of position on other outcomes were not statistically significant; however, these cannot be excluded considering the small numbers that were studied.

REVIEWER'S CONCLUSIONS

The prone position was found to slightly improve the oxygenation in neonates undergoing mechanical ventilation. However, we found no evidence concerning whether particular body positions during mechanical ventilation of the neonate are effective in producing sustained and clinically relevant improvements.

Symptomatology and development of urolithiasis in children with frequency-dysuria syndrome associated with hypercalciuria

To investigate the long-term outcome of the frequency-dysuria syndrome (FDS) with hypercalciuria (HCU), 19 children (15 girls and 4 boys; age range 15 months to 10 years) who presented with FDS alone (N=9) or with other associated clinical features (N=10; 6 with gross hematuria, 3 with microscopic hematuria and 1 with abdominal pain) were followed-up over 720 patient-months. Calcium loading test indicated absorptive HCU in 12 patients, renal HCU in 2, and in 5 the test was inconclusive. All patients were treated with a standard protocol after diagnosis. During follow-up, FDS recurred in 4 children, gross hematuria in 3, lumbar pain in 5, and 7 children developed urolithiasis within 3 to 60 months. The latter 7 children (4 with absorptive HCU and 1 with renal HCU) tended to be older than the other 12 (7.14 vs 5.08 years; p=0.11) and required a longer time to normalize urinary calcium excretion (16 vs 7 months; p <0.01). The initial urinary calcium excretion was similar between the patients with and those without stones (5.53 vs 5.6 mg/kg/d). In all other parameters measured, there were no statistically significant differences between the patients who initially presented with FDS alone and those with FDS accompanied with other urinary symptoms. We conclude that HCU and FDS in children can vary considerably in the clinical mode of presentation as well as its sequels. Significant risk for urolithiasis burdens the children who require a longer time (>12 months) to normalize their hypercalciuria.

Hypertrophic cardiomyopathy in mucopolysaccharidoses: regression after bone marrow transplantation

Mucopolysaccharide storage disease (MPS) presents clinically with a broad spectrum of abnormalities, among which cardiovascular involvement has been described. The echocardiographic findings have recently been reported for the various types of MPS. Among these, asymmetric septal hypertrophy (ASH) has been documented. We present a case of a 9-year-old girl suffering from type I MPS, atypical variant, with echocardiographic signs of ASH. She was given a bone marrow transplant after which the hypertrophic cardiomyopathy regressed.

Nicardipine in the treatment of outpatients with cerebrovascular disorders

A drug surveillance study was conducted, aimed at evaluating the efficacy and safety of nicardipine in outpatients with cerebrovascular diseases and at assessing the changes in nonfocal symptoms in the treated patients. The 3,150 outpatients (mean age, 68.9 years) were being treated by general practitioners and neurologists in Barcelona, Spain. Cerebral embolism was diagnosed in 4.0%, cerebral thrombosis in 13.0%, transitory ischemic attack in 28.0%, and chronic cerebral ischemia in 55.0%. The daily dose of nicardipine ranged from 20 to 180 mg; 87.7% of the patients received 60 mg of nicardipine daily. Concomitant medications were being taken by 89.1% of the patients. Treatment was evaluated in 2,913 patients. After 60 days of treatment, marked improvement was noted in 31.0% of the patients, moderate improvement in 39.0%, slight improvement in 20.0%, and no change in 10.0%. Marked or moderate improvement was noted in 69.6% of the patients who received nicardipine alone and in 66.9% of the patients who received concomitant medications. Clinically significant drops in blood pressure during treatment were found in the hypertensive patients. Side effects were reported by 14.5% of all patients and by 4.6% of the patients who received nicardipine alone. It is concluded that the daily administration of nicardipine is safe and effective in outpatients with cerebrovascular disorders.

Josamycin in the treatment of bronchopulmonary infections

The subjects were 6,033 outpatients, from every province of Spain, with acute bronchitis (44%), exacerbation of chronic bronchitis (35%), typical pneumonia (14%), or atypical pneumonia (8%). Most of the patients were aged 50 to 70 years. The dose of josamycin in over 90% of the patients was 2 gm daily. The mean duration of infection before treatment was 5.3 days and treatment lasted a mean of 9.2 days. Concomitant drugs were taken by 78% of the patients; these included mucolytic agents, xanthine derivatives, beta-adrenergic agonists, and corticosteroids. After two weeks of treatment, the infection was cured in 82% of the patients with acute bronchitis, in 30% with chronic bronchitis, in 85% with typical pneumonia, and in 85% with atypical pneumonia; improvement was shown by 16%, 66%, 13%, and 13%, respectively. Treatment side effects were noted in 11% of the patients receiving josamycin alone and in 17% of the patients receiving concomitant drugs. Most side effects were mild and transient; treatment was discontinued because of side effects in 2% of the patients receiving josamycin alone and in 3% receiving concomitant drugs. It is concluded that josamycin is a safe and effective agent in the treatment of bronchopulmonary infections.

Biochemical and histochemical adaptation to sprint training in young athletes

The purpose of the present study was to investigate the effects of 8 months of a specific and controlled sprint training programme on three groups of young athletes (two groups of males and one of females). Biopsies of vastus lateralis were taken before and after the period of training. The type percentage and diameter of the fibres, as well as the glycogen content and the activities of the enzymes of glycogen metabolism (glycogen synthase and glycogen phosphorylase), glycolysis (phosphofructokinase, pyruvate kinase, aldolase and lactate dehydrogenase), oxidative metabolism (succinate dehydrogenase) and creatine kinase and aminotransferases were studied. The results show an increase in the percentage of type I fibres and an increase in the diameter of both fibre types. A significant increase was also observed in glycogen content, and in the activities of glycogen synthase, glycogen phosphorylase, phosphofructokinase, pyruvate kinase, succinate dehydrogenase, aspartate aminotransferase and alanine aminotransferase. We conclude that a long period of sprint training induces a biochemical muscle adaptation to anaerobic exercise. This metabolic adaptation is followed by a morphological adaptation, although this is probably not as specific as the biochemical one.

Idiopathic infantile arterial calcification: unusual features

Idiopathic infantile arterial calcification (IIAC) is a rare disease of unknown etiology, which causes widespread arterial calcification and usually leads to early death from coronary arterial occlusion. Periarticular calcification has been reported in some cases. Two new cases are reported. In addition to the usual features of the disease, one was found to have ear-lobe calcification and the other an aortic aneurysm and coarctation of the aorta. Therapy with diphosphonate was apparently successful in one patient.