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Objectives: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact., Methods: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed., Results: 78 patients were included. At admission to the Emergency Department, treatment was modified for 91% of patients, and omitted for 9%. The most prescribed treatment was sliding scale insulin (68%). The treatments prescribed coincided in a 16.7% with the recommendations by the Spanish Society of Emergency Medicine. After intervention by the Pharmacist, the omission descended to 1.3%, and the adaptation to the recommendations increased to 20.5%. Comparing patients whose treatment coincided with the recommendations and those who did not, the clinical impact was respectively: mean glycemia at 24 hours: 138.3 } 49.5 mg/dL versus 182.7 } 97.1 mg/dL (p = 0.688); mean rescues with insulin lispro: } 1.6 versus 1.5 } 1.8 (p = 0.293); mean units of insulin lispro administered: 4.6 } 12.7 IU versus 6.6 } 11.3 IU (p = 0.155)., Conclusions: We found antidiabetic prescriptions to have a low adaptation to consensus recommendations. These results are in line with other studies, showing an abuse of sliding scale regimen as single hypoglycemic treatment., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction and Objectives: Since physiological pacing systems have become available, a debate has raged about the merits of atrial versus ventricular pacing in the sick sinus syndrome. The goal of this retrospective report was to study the long term incidence and the independent predictors for atrial fibrillation and stroke in 153 paced patients with sick sinus syndrome, adjusting for differences in baseline clinical variables with multivariate analysis., Method and Results: From 1980 to 1994, we implanted 32 dualchamber, 33 atrial, and 88 ventricular pacemakers to treat patients with sick sinus syndrome. After a maximum follow-up of 177 months (median 30 months for paroxismal atrial fibrillation, 45 months for chronic atrial fibrillation and 43,5 months for stroke) the actuarial incidence of paroximal atrial fibrillation was 7.8% at 1 year, 29% at 5 years and 42% at 10 years. The actuarial incidence of chronic atrial fibrillation was 1.3% at 1 year, 9.8% at 5 years and 22% at 10 years. Independent predictors for paroxismal AF from Cox's model was history of atrial tachyarrhythmias (p < 0.0001), chronic obstructive pulmonary disease (p = 0,006) and age (> 70 years-old) (p = 0.035). Only a history of atrial tachyarrhythmias before pacemaker implant was an independent predictor for chronic atrial fibrillation (p < 0.0001). The odd ratio for paroxismal atrial fibrillation in patients with previous atrial tachyarrhythmias and chronic atrial fibrillation were 6 (2.8-12) and 4 (1.6-9.7) (95% confiance limits). Actuarial incidence of stroke was 3% at 1 year, 10% at 5 years and 14% at 10 years. Independent predictors for stroke were history of peripheral vascular disease (p = 0.033) and hypertensive cardiomyopathy (p = 0.015). Development of paroxysmal and chronic atrial fibrillation during the follow-up were higher in patients with stroke (p < 0.001 and p < 0.05)., Conclusions: Development of atrial fibrillation and stroke in paced patients with sick sinus syndrome are strongly determined by clinical variables. Preimplant paroxysmal atrial tachyarrhythmias is the most important predictor for atrial fibrillation in the follow-up.

Background: It is clear that permanent cardiac pacing in patients with sick sinus syndrome is effective. In spite of a normal pacemaker function, syncope may occur. Causes often remain unknown. The objective of this study was to review our current experience with these patients to identify predictors and etiologies of these symptoms., Method and Results: We studied 153 patients who received atrial, ventricular and dual-chamber pacemakers for sick sinus syndrome. During a median follow-up of 57.6 months (1-177 months), actuarial incidence of syncope or near syncope was 4.5% at 1 year, 9% at 5 years and 13% at 10 years. Causes were related with autonomic insufficiency (45%), pacemaker/lead malfunction (30%), pacemaker syndrome (10%) and conduction disturbances in patients with AAI pacemakers (10%). In only one patient (5%) syncope remained unexplained. Preimplant predictors for syncope were gender (male) and age (< 70 years old)., Conclusions: 1) Syncopes in paced patients with sick sinus syndrome have multiple etiologies and may be multifactorial; 2) Autonomic dysfunction and "oversensing" in troubleshooting of implanted cardiac pacemakers could provide an explanation for recurrent syndrome in over 70% of these patients; 3) A better evaluation of neurogenic syncope may be necessary before pacemakers are implanted, to prevent recurrent syncope.

Objectives: An analysis is made of the automatic beat-by-beat measurement of QT and other intervals related to ventricular repolarization. The variability pattern of these intervals is investigated in normal subjects at rest, along with their relation to RR cycle variability., Material and Methods: The electrocardiographic signals (LII) from 11 normal subjects (mean age 31 +/- 10 years) were recorded over 5 min and processed by applying specific algorithms to determine beat-by-beat the RR, QT, RT, QTm and RTm intervals (Tm = peak of T wave). An analysis was made of the variability of these intervals in the time (standard deviation, variation coefficient, difference between maximum and minimum values) and frequency domains (spectral analysis applying the Fourier transform)., Results: The differences between the automatic measurements and those performed by two observers (n = 110) were respectively -1.3 +/- 6.4 and -3.7 +/- 6.5 ms for QT, - 1.0 +/- 1.4 and -1.0 +/- 2.3 ms for QTm, -0.3 +/- 1.4 and -0.2 +/- 1.8 ms for RTm, and 0.7 +/- 6.5 and -2.8 +/- 10.3 ms for RT. The QT and RT intervals exhibited greater variability (SD = 6 +/- 1 ms) than QTm and RTm (SD = 3 +/- 1 ms, p < 0.0001). These differences persisted on comparing the corresponding variation coefficients. The differences between the maximum and minimum measurements were 45 +/- 24 ms for QT and RT, the values being significantly less in the case of QTm (21 +/- 26 ms, p < 0.05) and RTm (20 +/- 27 ms, p < 0.05). In the frequency domain, the high- (HF) and low-frequency (LF) band energies were low in the series formed by the ventricular repolarization intervals, and the LF band normalized amplitude was significantly lower than in the RR series. There were no significant differences in the frequencies of the maximum values of the LF and HF bands of the RR series with respect to the QT series. The correlations between the RR intervals and the subsequent repolarization intervals obtained in each subject were not significant in 7 of the 11 subjects studied., Conclusions: The automatic beat-by-beat determination of the ventricular repolarization intervals is precise, particularly when considering the intervals defined by the T wave peak. Repolarization variability during the sinus rhythm at rest is small, and is not linearly related to modifications of the previous RR interval. Neurovegetative and humoral influences are postulated to explain QT variations. The neurovegetative and humoral influences that regulate cardiac cycle and ventricular repolarization variability at rest, are found to be quantitatively different.

Background: The aim of the present controlled study was to assess the effect of subcutaneous administration of desmopressin acetate (DDAVP) on the yield of Factor VIII (FVIII) and von Willebrand Factor (vWF) obtained in cryoprecipitates after plasmapheresis collection., Subjects and Methods: Fifteen plasma donors underwent twice plasmapheresis collections using an "Autophereses C. model A-201" and cryoprecipitates were prepared using standard methods. In every subject of study one of the procedure was performed 35 min after subcutaneous administration of DDAVP (0.3 micrograms/kg), obtained from a highly concentrated preparation of the drug (40 micrograms/ml). Prior to the other apheresis procedure no chemicals were administered. Evaluation of FVIII and vWF levels was performed in peripheral blood samples obtained at different time points and cryoprecipitates product samples., Results: Administration of DDAVP led to two-fold increase the yield of FVIII and vWF immediately before the performance of plasmapheresis. DDAVP stimulation resulted in an increase in the yield of FVIII and vWF in cryoprecipitates, compared with levels in the absence of the drug (703 +/- 53 and 768 +/- 51 U versus 227 +/- 12 and 362 +/- 20 U, respectively). No adverse effects but flushing were observed after DDAVP administration., Conclusions: Subcutaneous administration of DDAVP prior to plasma collection is a safe method to improve drastically the content of FVIII and vWF in cryoprecipitates. This procedure should be considered as an useful tool to help in providing self-sufficiency of plasma.

We show the results of a retrospective study designed to assess the features of transient job disability (TJD) episodes of workers from two groups (clerks and nurses) from an urban health basic zone with 24,536 inhabitants, out of which 6,009 were active workers registered in social security databases. Population pyramid and job distribution in active workers were obtained from a random sample including 5% of the active population, out of which 17% were clerks and 5.54% nurses. There were 1098 TJD episodes in 1990; 32.4% of them involved clerks and 8.3% nurses. The mean length of episodes was 28.2 days in nurses and 27.8 days among clerks, compared to 32.4 days in the active population. These differences remained (p < 0.001) even after excluding TJD episodes of pregnant women, in whose case the mean length of episodes involving male or female workers was the same. The percentage of TJD episodes was higher among female nurses and clerks, than among the whole female population. Influenza was responsible for 20.5% of TJD in clerks against 14.3% among nurses and 14.8% in the whole active population. We conclude that, in the groups studied, the rate of job absenteeism was higher than in the whole population, and higher in female than in males. However, in the whole population, there were no differences in TJD rates between males and females. We discuss that several factors other than illness may explain the differences among groups.

Objective: To analyse whether the variables of gender, age and type of job of those in full-time work affect short-term unfitness for work (SUW) in a study undertaken within our health area., Design: A prospective and retrospective study of all the SUW., Setting: Primary Care. An urban Health Centre., Participants: Those people with full-time jobs registered at the Centre., Main Measurements and Results: The entire 1098 certificates of SUW issued in 1990 were processed. The population pyramid and job distribution among those in full-time work was obtained by a random sample of 5% of the active population. When time off for maternity (TOM) was excluded, women accounted for 44.8% of SUW and men 55.2%. There were no significant differences with the percentages these figures represent for the active population as a whole. The number of SUW per 100 people in work was 15.9 for men and 21.5 and 17.4 for women (including and excluding TOM, respectively). The average length of SUW, excluding maternity, was 27.06 days for men and 26.8 for women. On the question of age, those under 19 and over 40 contributed least to the SUW percentage. Additionally, those under 19 and over 60 were the proportions of the population least prone to SUW. On the question of type of job, we found a higher contribution to absenteeism than expected within Groups 3 and 4 and less in Groups 0/1, 5 and 7/8/9. The longest average length of time for SUW was in Group X (84.2 days/SUW)., Conclusions: Excluding TOM, gender does not appear to be a variable that affects SUW. Age group and type of job are variables affecting SUW. It will be necessary to undertake research into whether there are additional social or labour factors which might explain.