Rodriguez-Nunez A.,Hospital Clinico Universitario Of Santiago Of Compostela |
Moure-Gonzalez J.,Hospital Clinico Universitario Of Santiago Of Compostela |
Rodriguez-Blanco S.,Hospital Of Leon |
Oulego-Erroz I.,Hospital Of Leon |
And 2 more authors.
European Journal of Pediatrics | Year: 2014
Our objective was to test the ability of pediatric residents to intubate the trachea of infant and child manikins during continuous chest compressions (CC) by means of indirect videolaryngoscopy with Glidescope® versus standard direct laryngoscopy. A randomized crossover simulation trial was designed. Twenty-three residents trained to intubate child and infant manikins were eligible for the study. They were asked to perform tracheal intubation in manikins assisted by both standard laryngoscopy and Glidescope® while a colleague delivered uninterrupted chest compressions. In the infant cardiac arrest scenario, the median (IQR) total time for intubation was significantly shorter with the Miller laryngoscope [28.2 s (20.4–34.4)] than with Glidescope® [38.0 s (25.3–50.5)] (p = 0.021). The number of participants who needed more than 30 s to intubate the manikin was also significantly higher with Glidescope® (n = 13) than with the Miller laryngoscope (n = 7, p = 0.01). In the child scenario, the total time for intubation and number of intubation failures were similar with Macintosh and Glidescope® laryngoscopes. The participants’ subjective difficulty of the procedure was similar for direct and videolaryngoscopy. Conclusion: In simulated infant and child cardiac arrest scenarios, pediatric residents are able to intubate the trachea during CC. The videolaryngoscope Glidescope® does not improve performance in this setting. © 2014, Springer-Verlag Berlin Heidelberg.
Gonzalez-Juanatey J.R.,Hospital Clinico Universitario Of Santiago Of Compostela |
Cordero A.,Hospital Universitario Of San Juan
Expert Review of Cardiovascular Therapy | Year: 2013
Angiotensin-converting enzyme inhibitors (ACEIs) are the first-line therapy for the treatment of hypertension. However, not all ACEIs are equal. Delapril is a nonsulfhydryl ACEI with unique properties. Delapril has a high lipophilicity and weak bradykinin potentiating action. As a result, delapril has a more potent inhibition capacity of vascular wall angiotensin-converting enzyme activity and a lower incidence of cough than enalapril or captopril. With regard to efficacy, delapril has a long-lasting antihypertensive effect with a trough/peak ratio that is in the upper range of different ACEIs and a positively high smoothness index. Thus, delapril effectively and smoothly reduces blood pressure over 24 h. Moreover, the benefits of delapril are not limited to hypertensive patients, but also in those with microalbuminuria, left ventricular hypertrophy, myocardial infarction or heart failure; delapril appears to be effective and well tolerated. © 2013 Expert Reviews Ltd.
Viso E.,Complexo Hospitalario Of Pontevedra |
Rodriguez-Ares M.T.,Hospital Clinico Universitario Of Santiago Of Compostela |
Rodriguez-Ares M.T.,University of Santiago de Compostela |
Abelenda D.,Complexo Hospitalario Of Pontevedra |
And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2012
Purpose. To describe epidemiologic characteristics of asymptomatic and symptomatic meibomian gland dysfunction (MGD) in a general adult population in northwestern Spain. Methods. A total of 1155 subjects aged 40 years and older were selected by an age-stratified random sample procedure in O Salnes, Spain. A standardized symptoms questionnaire was administered and a comprehensive ophthalmic evaluation, which included ocular surface tests, was carried out. Absent, viscous, or waxy white secretion upon digital expression, lid margin telangiectasia or plugging of the meibomian gland orifices was considered evidence of MGD. The prevalence and associations of asymptomatic and symptomatic MGD, and their effects on the ocular surface, were investigated. Results. From 937 eligible subjects, 619 (66.1%) participated (mean age [SD], 63.4 [14.5] years; range, 40-96; 37.0% males). The prevalence of asymptomatic MGD was 21.9% (95% confidence interval [CI], 18.8-25.3). This prevalence increased with age (P - 0.000) and was higher in males than in females (P - 0.003). The prevalence of symptomatic MGD was 8.6% (95% CI, 6.7-10.9). This prevalence also increased with age (P = 0.000) but was not associated with sex. Abnormal tear breakup time and fluorescein staining prevalence estimates were higher among asymptomatic subjects. After controlling for age and sex, asymptomatic MGD was associated with diabetes (adjusted odds ratio [OR a] 2.23) and cardiovascular disease (OR a 1.80), and symptomatic MGD with rosacea (OR a 3.50) and rheumatoid arthritis (OR a 16.50). Conclusions. Asymptomatic MGD is more common than symptomatic MGD. Symptomatology is not associated with secondary damage to the ocular surface. Some systemic diseases may lower whereas others may raise the risk of developing symptoms. Symptom-based approaches do not seem appropriate for MGD estimation. © 2012 The Association for Research in Vision and Ophthalmology, Inc.
Bouzon-Alejandro M.,Hospital Clinico Universitario Of Santiago Of Compostela
BMC pediatrics | Year: 2011
The effect of rotavirus in developed countries is mainly economic. This study aimed to assess the indirect costs induced by rotavirus acute gastroenteritis (RVAGE) in Spain. A prospective observational study was conducted from October 2008 to June 2009. It included 682 children up to 5 years of age with acute gastroenteritis (AGE) who attended primary care (n = 18) and emergency room/hospital settings (n = 10), covering the regions of Galicia and Asturias (North-west Spain). All non-medical expenses incurred throughout the episode were recorded in detail using personal interviews and telephone contact. Among the 682 enrolled children, 207 (30.4%) were rotavirus positive and 170 (25%) had received at least one dose of rotavirus vaccine. The mean (standard deviation) indirect cost caused by an episode of AGE was estimated at 135.17 (182.70) Euros. Costs were 1.74-fold higher when AGE was caused by rotavirus compared with other etiologies: 192.7 (219.8) Euros vs. 111.6 (163.5) Euros (p < .001). The costs for absenteeism were the most substantial with a mean of 91.41 (134.76) Euros per family, resulting in a loss of 2.45 (3.17) days of work. In RVAGE patients, the absenteeism cost was 120.4 (154) Euros compared with 75.8 (123) for the other etiologies (p = .002), because of loss of 3.5 (3.6) vs 1.9 (2.9) days of work (p < .001). Meals costs were 2-fold-higher (48.5 (55) vs 24.3 (46) Euros, p < .001) and travel costs were 2.6-fold-higher (32 (92) vs 12.5 (21.1) Euros, p = .005) in RVAGE patients compared with those with other etiologies. There were no differences between RVAGE and other etiologies groups regarding costs of hiring of caregivers or purchase of material. Patients with RVAGE were admitted to hospital more frequently than those with other etiologies (47.8% vs 14%, p < .001). Rotavirus generates a significant indirect economic burden. Our data should be considered in the decision-making process of the eventual inclusion of rotavirus vaccine in the national immunization schedule of well developed countries.
Cortinas Diaz J.,Hospital Clinico Universitario Of Santiago Of Compostela
Revista española de anestesiología y reanimación | Year: 2011
The anesthesiologist's chief responsibility is to ensure ventilation of the patient who is undergoing surgery or to apply resuscitation measures in life-threatening situations. Cricothyrotomy is one among many options available for maintaining airway patency. Usually it is the last resort but can be a lifesaving maneuver in the cannot-intubate, cannot-ventilate patient. The various types include cannula insertion, percutaneous puncture and dilatation, and surgical cricothyrotomy; techniques may be combined, as in the case of surgically inserting a cannula over a trocar.
Martinon-Torres F.,Hospital Clinico Universitario Of Santiago Of Compostela
Journal of Adolescent Health | Year: 2016
Invasive meningococcal disease remains a substantial global public health burden despite being vaccine-preventable worldwide. More than one million cases are reported annually, with average fatality rates ranging from 10% to 40% depending on clinical presentation and geographic location. Survivors may suffer debilitating sequelae that reduce the quality of life for the patient and family members responsible for their care. Major financial burdens are associated with acute treatment and follow-up care, and outbreak management often places extensive financial strains on public health resources. Although the clinical and financial aspects of meningococcal disease burden are straightforward to quantify, other burdens such as lifelong cognitive deficits, psychological stress, adaptive measures for reintegration into society, familial impact, and legal costs are systematically overlooked. These and other facets of disease burden are therefore not systematically considered in cost-effectiveness analyses that public health authorities take into consideration when making decisions regarding vaccination programs. Changing the approach for measuring meningococcal disease burden is necessary to accurately understand the societal consequences of this devastating illness. In this article, the conventional and under-recognized burdens of meningococcal disease are presented and discussed. © 2016 Society for Adolescent Health and Medicine
Noia J.L.,Hospital Clinico Universitario Of Santiago Of Compostela
Gastroenterologia y Hepatologia | Year: 2015
Pancreatic cancer continues to have an extremely poor prognosis. There have been hardly any therapeutic advances in the last few years and consequently attention is focussed on early diagnosis. In this regard, endoscopic ultrasonography and several associated techniques, such as electrography or the use of intravenous contrast agents, continue to be the cornerstone of differential diagnosis. In the latest Digestive Diseases Week, numerous presentations were made on cystic pancreatic tumours, especially intraductal papillary mucinous tumours, with their well-known potential for malignant transformation. In addition to the problems of the preoperative characterization of these entities, by both endoscopic ultrasound cytological evaluation-even with the presence of an on-site pathologist -and by intracystic markers, the role of other techniques was also mentioned, such as confocal laser endomicroscopy or the use of intravenous contrast agents to characterize the wall nodule. There were numerous studies on the natural history of intraductal papillary mucinous tumours, which mainly supported the increasingly conservative approach adopted by the recent Fukuoka international guidelines. Certain aspects were highlighted, such as comorbidities, when considering surgery, or the growth rate of the tumour. In treatment, endoscopic ultrasound-guided injection of gemcitabine and paclitaxel, without the need for alcohol as an ablative treatment of mucinous cystic tumours, is gaining ground in specific cases. © 2015 Elsevier España, S.L.U.
Iglesias-Garcia J.,Hospital Clinico Universitario Of Santiago Of Compostela
Gastroenterologia y Hepatologia | Year: 2011
Cancer of the pancreas is a disease that is difficult to manage, particularly because of its poor prognosis. The importance of screening in at-risk patients is growing, especially screening based on endoscopic ultrasound (EUS). Risk factors continue to be identified, such as saccharose, smoking, and cystic lesions, while protective factors have also come to light, such as vitamin E. There also seems to be a close relation between pancreatic cancer and diabetes mellitus, with a subgroup of patients at greater risk of developing pancreatic cancer in the two years after diagnosis of diabetes. From the diagnostic point of view, EUS is the most widely developed test, in association with elastography and EUSguided biopsy. This test is the most effective in obtaining and processing the samples and often allows immunohistochemical analyses, which improve diagnostic performance. Notable among treatment options are high-frequency ultrasound and cryotherapy. The incidence of cystic tumors of the pancreas is increasing. In these tumors, EUS has become the technique of choice. Most studies aim to optimize the management of these lesions (especially intraductal papillary mucinous tumors) and attempt to determine those suitable for conservative management. © 2011 Elsevier España S.L.
Ramos P.M.,Hospital Clinico Universitario Of Santiago Of Compostela
Revista Espanola de Cardiologia Suplementos | Year: 2015
Statins are drugs that reduce the plasma low-density lipoprotein cholesterol level. They have been shown to be effective for both primary and secondary cardiovascular prevention. These drugs can be classified according to their lipid-lowering capacity and are considered to have a high potency or high intensity if they can reduce levels by approximately 50%. In addition, they have other effects that do not appear to be explained solely by their ability to reduce the cholesterol level. It is thought these effects are related to other properties of the drugs (e.g. their antioxidant, anti-inflammatory or antithrombotic properties) which are associated with their actions on G proteins. These extralipid effects have been studied in various cardiovascular diseases and in other conditions, such as sepsis, cancer and dementia. However, existing data are not clear enough to justify extending the therapeutic indications of statins beyond cholesterol reduction. © 2015 Sociedad Española de Cardiología.
Cardiovascular risk in the 21st century: Identifying risk in primary prevention. Controlling risk in secondary prevention [Riesgo cardiovascular en el siglo XXI. Cómo detectarlo en prevención primaria. Cómo controlarlo en prevención secundaria]
Mazon-Ramos P.,Hospital Clinico Universitario Of Santiago Of Compostela
Revista Espanola de Cardiologia | Year: 2012
If a primary prevention strategy for cardiovascular disease is to be implemented successfully, it is essential to have some knowledge of the level of risk in the general population, long before clinical disease appears. Traditionally, risk stratification has been based on risk factors that were first described some 50 years ago. However, we know that we are not able to identify all individuals who could present with a cardiovascular condition. in recent years, various techniques, principally imaging techniques, have been developed for detecting subclinical vascular disease, but they have not yet been approved for general use. While we will clearly witness changes in cardiovascular risk assessment in the future, until then we must make use of every available tool to ensure that any patient who needs our expertise does not escape our attention. Once a patient presents with clinical symptoms of cardiovascular disease or is known to have silent disease, we must implement secondary prevention measures to avoid the appearance of additional clinical conditions. in addition to strictly controlling risk factors, we must also make use of both drug treatment and surgical revascularization, strategies that have been demonstrated to be effective but which are underutilized. Above all, there is the unfinished business of modifying lifestyles to encourage healthier habits. Considerable medical progress will be lost if we do not improve our diet, exercise regularly and completely ban smoking. © 2012 Sociedad Española de Cardiología. Publicado por Elsevier España, SL. Todos los derechos reservados.