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Fernandez Prieto R.M.,Hospital Universitario Puerto Real
Revista española de anestesiología y reanimación | Year: 2011

The antagonism of steroidal nondepolarizing neuromuscular blockers (NDMBs) moved forward recently with the introduction of sugammadex, the only drug able to immediately reverse the effects of curarization produced by NDMBs. This advance has necessitated reflection on the future role of pseudocholinesterase. In spite of the side effects of succinylcholine and published opinions on its use, this NDMB continues to be used in clinical anesthesia. Pseudocholinesterase is mainly found in the liver, plasma, and nervous system. The enzyme is synthesized in the liver in greater amounts than required although certain conditions lead to deficiency, which is usually asymptomatic. The only clinical expression is the apnea which develops after administration of succinycholine because this NDMB cannot be metabolized. In some patients, slight reductions in the antagonism of succinylcholine lead to rising neuromuscular concentrations of the drug in accordance with the degree and duration of the blockade. We review the various forms of pseudocholinesterase deficiency, including a discussion of genetic variants, clinical manifestations, and management. In addition to discussing the diagnosis of this condition and the clinical implications, we highlight the importance of practice protocols and access to a referral laboratory if one is not available within the immediate hospital. Source


Carmona-Espinazo F.,Hospital Universitario Puerta del Mar | Sanchez-Prieto F.,Hospital Universitario Puerta del Mar | Lopez-Saez J.B.,Hospital Universitario Puerto Real
Revista Espanola de Medicina Legal | Year: 2016

Aim: To determine the frequency of palliative sedation in our unit, to know the characteristics of the patients to whom it was applied and to describe the therapeutic measures that were employed. Material and methods: Observational retrospective study of all patients who were admitted and died in the Palliative Care Unit of the Puerta del Mar University Hospital (Cádiz, Spain) between January 1st 2013 and December 31st 2013. All of them were oncology patients. The data were obtained from the medical records. A descriptive analysis of all the collected variables was performed. Results: A total of 290 patients were admitted; 92 died (31.7%). Among the latter, sedative treatment was applied to 25 (27.2%). About half of these were male (52.0%) and their mean age was 61.7 years (SD 10.2). The most common refractory symptom was dyspnea (36.0%). In all cases midazolam was used for sedation, alone or in combination with levomepromazine. Its route of administration was intravenous or subcutaneous. Conclusions: The clinical profile of patients requiring palliative sedation was: male, of 62 years of age, oncological and with dyspnea as refractory symptom. The most employed drug was midazolam. © 2015 Asociación Nacional de Médicos Forenses. Source


Tibaldi G.,Centro Studi e Ricerche in Psichiatria | Salvador-Carulla L.,PSICOST Research Association | Garcia-Gutierrez J.C.,Hospital Universitario Puerto Real
Current Clinical Pharmacology | Year: 2011

Treatment adherence is related to "self-regulation" of prescribed drugs. Patients organise their drug intake around their own priorities, which may be very different from prescribers' priorities, since most of the patients value theirpersonal concerns and/or their social roles more than the benefits of a prescribed treatment. A gap exists between patients'and professionals' views. This gap is mainly related to patients' health beliefs and physicians' attitudes. A number ofstrategies can help professionals overcome gaps between their treatment options for depression and schizophrenia and the"real world" alternatives shared by the lay public, patients, their relatives, and political stakeholders. These strategiesinclude integrated care and recovery, family engagement, and the development of a mutualistic patient/physicianrelationship with the adoption of advance directives and appropriate guidelines that incorporate the patient's choices. Theeffective implementation of these combined strategies within the person-centred care model empowers patients tocollaborate with mental health professionals and their families in making complex health care choices. Barriers to thisprocess include factors affecting the control, contact and communication facets of the patient/physician relationship. © 2011 Bentham Science Publishers Ltd. Source


Bover J.,Fundacio Puigvert | Perez R.,Hospital Infanta Leonor | Molina M.,Hospital Santa Maria del Rosell | Benavides B.,Hospital Universitario Puerto Real | And 4 more authors.
Nephron - Clinical Practice | Year: 2011

Background: Cinacalcet reduces intact parathyroid hormone (iPTH), Ca and P serum levels in patients with secondary hyperparathyroidism (SHPT). Methods: This Spanish, multicenter, observational, retrospective study collected data from SHPT dialysis patients 12 weeks before and up to 72 weeks after starting cinacalcet in clinical practice. Results: Data from 428 patients with uncontrolled SHPT despite receiving standard of care (29% with baseline iPTH 501-800 pg/ml; 51% with >800 pg/ml) were collected. Percentages of patients within National Kidney Foundation Kidney Disease Outcomes Quality Initiative targets at baseline and 72 weeks were: iPTH, 0 versus 32.5% (p < 0.05); Ca, 40.1 versus 50% (p < 0.05); P, 47.7 versus 53.8% (p = 0.162). Vitamin D sterol use decreased from 53.3% at baseline to 36.7% at 72 weeks (p < 0.05). The mean ± SD cinacalcet dose at 72 weeks was 44.0 ± 25.8, 51.7 ± 31.3 and 57.1 ± 37.0 mg for patients with baseline iPTH 301-500, 501-800 or >800 pg/ml, respectively. The main adverse reactions were nausea (5.4%), dyspepsia (5.1%) and vomiting (3.7%). Conclusions: The introduction of cinacalcet improved the routine clinical management of SHPT in a large cohort of Spanish dialysis patients. Cinacalcet is effective and well tolerated regardless of disease severity, and maintains its efficacy over 72 weeks. Copyright © 2010 S. Karger AG, Basel. Source


This article discusses basic features of nutritional support in critically-ill patients: general indications, the route of administration and the optimal timing for the introduction of feeding. Although these features form the bedrock of nutritional support, most of the questions related to these issues are lacking answers based on the highest grade of evidence. Moreover, progresiprospective randomized trials that might elucidate some o f these questions would probably be incompatible with good clinical practice. Nevertheless, nutritional support in critically-ill patients unable to voluntarily meet their own nutritional requirements is currently an unquestionable part of their treatment and care and is essential to the successful management of their illness. © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. Source

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