Search

Abstract Objectives The aim of this study is to analyze the association between the degree of frailty and inappropriate prescribing patterns at admission to an Acute Care of the Elderly Unit (ACE Unit). Methods Prospective observational study conducted in the ACE Unit of an acute hospital in Barcelona city between June and August 2021. Epidemiological and demographic data were collected during hospitalization. Comprehensive geriatric assessment was performed on admitted patients. We recorded frailty (FRAIL scale), extreme polypharmacy (10 or more drugs), central nervous system potentially inappropriate medications‐PIMs (STOPP‐CNS or group D), cardiovascular potential prescribing omissions‐PPOs (START‐CV or group A), and anticholinergic burden using the drug burden index (DBI). Results Ninety‐three patients were included, of whom 48 (51.6%) were male, with a mean age of 82.83 (SD 7.53) years. The main diagnosis upon admission was heart failure in 34 patients (36.6%). Frail patients were older, with more dependence of activities of daily living and more comorbidity than non‐frail patients. Additionally, frail patients demonstrated more omissions according to the START‐A criteria. No statistically significant differences were observed in term of extreme polypharmacy, PIMs, or anticholinergic burden. Conclusions In the current study we found an association between frailty and inappropriate prescribing, specifically with regard to omissions using the START criteria for the cardiovascular system (group A). Notably, frail patients exhibited more omissions compared to their non‐frail counterparts, and this difference was statistically significant.

Background: Anterior cruciate ligament (ACL) tears are common, especially in athletes, and are often treated with hamstring tendon autografts using a single-bundle technique. Graft diameter is crucial, with evidence showing that larger grafts reduce failure risk. Asian populations typically have smaller graft diameters. This study compares the clinical outcomes of the five-strand versus the quadrupled technique in a Filipino Asian population to assess potential benefits in graft thickness and knee stability. Objective: To compare the functional outcomes, graft sizes, failure rates, and time to return to sports between five-strand and quadrupled hamstring tendon autografts in ACL reconstruction. Methodology: This ambi-directional cohort study involved Asian Filipino patients aged 18–50 with unilateral ACL tears who underwent single-bundle ACL reconstruction with either quadrupled or five-strand hamstring autografts between January 2022 and August 2023. Data on graft dimensions, IKDC scores, and time to return to sports were collected pre- and postoperatively. The analysis included descriptive statistics, Fisher’s exact test, t-tests, and ANOVA, with significance at p < 0.05. Result: The study included 18 patients, showing no significant differences in demographic characteristics such as age (24.78 vs. 27.67 years, p = 0.202), height (1.71 vs. 1.64 meters, p = 0.146), weight (84.43 vs. 74.98 kg, p = 0.252) or body mass index (28.95 vs. 27.98 kg/m², p = 0.714); average return to sports (10.63 vs. 11.83 months, p = 0.642). There was no significant difference in thicknesses (p = 0.089) and lengths (p = 0.885) of the graft. IKDC scores showed no significant differences between the two groups in pre- or postoperative outcomes at six months and one year. Complications were minimal, with no significant difference found. Conclusion: Both the five-strand and quadrupled techniques demonstrated similar demographics, graft dimensions, and clinical outcomes, indicating comparable functional results and safety profiles.

Purpose: The aim of this study is to analyse adverse health outcomes at hospital discharge adjusted to frailty degree measured by three instruments in patients admitted for medical diseases in an Acute Care for Elders (ACE). Methods: This is a prospective observational study, including 194 frail patients aged 75 years or older. Patients were admitted to a tertiary hospital ACE for an acute medical illness or exacerbated chronic diseases from June 2022 to May 2023. Frailty was assessed by the FRAIL scale, the Clinical Frailty Scale (CFS) and the frail-VIG Index (IF-VIG). Health outcomes analysed were length of hospital stay, home destination at hospital discharge, development of delirium and functional decline. Results: Patients were on average 85,14 years old, with 56 % women. Mean frailty punctuations were 2,83 for FRAIL scale; 4,1 for CFS and 0,3 for IF-VIG. Patients who did not return home were more fragile: FRAIL 3,1 vs 2,6; CFS 4,5 vs 4,0; IF-VIG 0,3 vs 0,2. Patients with a hospitalization longer than 10 days were more fragile: FRAIL 3,9 vs 2,6; CFS 4,5 vs 3,8; IF-VIG 0,3 vs 0,2. More frail patients had greater delirium incidence and prevalence: CFS 4,7 vs 4,1; IF-VIG 0,3 vs 0,2. These results are statistically significant. Conclusions: A greater degree of basal frailty during a hospitalisation in an ACE is strongly related with smaller return home rates at hospital discharge, as well as with longer mean stay-length and larger amounts of delirium.

This article presents the theoretical study and experimental validation of the multipactor (MP) effect in bandpass filters implemented in groove gap waveguide (GGW) technology. Such filters are based on rectangular cavities and inductive coupling irises, whose optimized dimensions (widths and lengths) are fixed between rows of metal pins. For the effective design of the considered GGW filter, an equivalent counterpart in standard rectangular waveguide (RW) technology will be first studied, using very efficient tools for computing its electrical response and MP discharge breakdown levels. Two prototypes of the GGW and RW bandpass filters, designed to operate at 17.5 GHz (for Ka-band satellite downlink applications), are manufactured for validation and comparison purposes. Both of them are made of aluminium material, whose properties (in terms of secondary electron emission) have also been measured, as well as considered in the prediction of MP threshold levels using available software tools. Proceeding in this way, an outstanding matching between all simulated and experimental results of the MP effect has been achieved.

The electrical response of low-frequency band-pass filters based on periodic substrate integrated waveguide (SIW) technology typically shows permitted and forbidden frequency bands. Therefore, this type of filters can be designed using a conceptually very simple and efficient procedure based exclusively on the study of the dispersion properties of the periodic structure. In this paper, we go a step further with the design of a periodically air-filled SIW band-pass filter in which part of the dielectric substrate is removed to reduce insertion losses, and whose unit cell parameters, which are directly related to the center frequency ( $f_{c}$ ) and bandwidth (BW) of the first passband, and also to the first stopband or bandgap (BG) of the structure, have been appropriately selected for filtering purposes, thus providing some useful design rules. Furthermore, we apply the concept of glide symmetry for achieving a much larger fractional bandwidth (FBW) than that obtained in conventional air-filled SIW filters found in the technical literature. Finite implementations of both periodic structures with and without glide symmetry have been analyzed, showing their filtering response for validation purposes. Additionally, to overcome the matching level restrictions in the resulting air-filled periodic SIWs, a microstrip-to-SIW transition including a novel coupling iris is proposed. A prototype of the proposed air-filled glide-symmetric periodic SIW filter has been manufactured and experimentally validated, illustrating the potential of this technique to obtain large FBWs that can not be achieved in conventional air-filled SIW filters. The proposed filter proves to be a good candidate for millimeter wave applications.

Background: Aging correlates with increased frailty, multi-morbidity, and chronic diseases. Furthermore, treating the aged often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Few guidelines and tools address the problem of polypharmacy and MRPs, mainly within the institutionalized elderly population. Routine pharmacological review is needed among institutionalized patients. This pharmacological review may improve with a multidisciplinary approach of a collaboration of multiple health professionals. This study aimed to describe institutionalized patients, systematically review their medication plans, and then give recommendations and identify MRPs.Methods: A cross-sectional study was performed using data obtained from patients living in five nursing homes in the northern area of Barcelona, Spain. The inclusion criteria comprised institutionalized patients with public health coverage provided by the Health Department of Catalonia. A detailed description of the clinical characteristics, chronic diseases, pharmacological treatments, recommendations, incomplete data, and MRPs, such as potential drug–drug interactions, therapeutic duplications, contraindications, and drugs deemed inappropriate or of doubtful efficacy, was made. The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs.Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years, and 72.0% were female individuals. All patients had at least three health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients. Of these recommendations, verification of adequate use was made for 69.3% and withdrawal of a drug for 49.5%.Conclusion: This study demonstrates a high prevalence of health-related problems and several prescribed drugs in nursing homes in Catalonia. Many recommendations were made, confirming the increased proportion of polypharmacy, MRPs, and the need for standardized interventions. A multidisciplinary team approach, including general practitioners, geriatric assessments, a clinical pharmacist, and a clinical pharmacologist, should address this problem.

Resumen: Las visitas de pacientes con multimorbilidad, cronicidad compleja y fragilidad a los servicios de urgencias hospitalarios son un desafío creciente. Se presenta una estrategia local, basada en listados de preselección automatizada, una enfermera gestora de casos con experiencia específica y un consenso de derivación multinivel. Se muestra la factibilidad con 368 alertas identificadas, el 85% (n = 315) bien seleccionadas. La edad, la fragilidad, el porcentaje de atención domiciliaria, el índice de Barthel y la cognición fueron consistentes con los niveles de atención/derivación (primaria, intermedia y especializada) según criterios previamente consensuados. Con la generalización actual de los sistemas de información y análisis de datos, el rol creciente de enfermería avanzada y unos recursos sanitarios bien estructurados entre niveles, una selección automatizada, junto al consenso en circuitos y perfiles clínicos y la valoración autónoma de enfermería gestionando casos multifrecuentadores, podría mejorar, de forma proactiva y sencilla, una distribución entre niveles de las alertas más coherente con las necesidades sociosanitarias. Abstract: Visits to hospital emergency departments by patients with multimorbidity, complex chronic conditions, and frailty are becoming an increasing challenge. A territorial strategy has been developed, based on automated preselection lists, a nurse case manager with specialized experience, and a multi-level territorial referral consensus. The feasibility of this approach has been demonstrated, with 368 alerts detected, 85% of which were well-selected. Age, frailty, home care percentage, Barthel index, and cognition were progressively aligned with levels of care/referral (primary, intermediate, and specialized) according to previously agreed criteria. In 2024, there is extensive structured technical information, an expanding role for advanced nursing, and well-established inter-level service resources. Therefore, through automated selection, a consensual territorial protocol of pathways and clinical profiles, and autonomous nursing assessments managing multi-frequent cases, it would be possible to achieve, in a proactive, simple, and scalable manner, an appropriate distribution of alerts across levels, consistent with the social and healthcare needs of the patients.

In this paper, we discuss how the use of the recently developed modified tuning pin (MTP) can be extended to the design of filters and diplexers implemented in rectangular waveguide, that can be reconfigured in a number of discrete states, and that can be used in high-power payloads. As an application example, the design of two reconfigurable filters and a reconfigurable diplexer is fully described. The high-power behavior of these components (in particular, with respect to corona and multipaction effects) is also studied in detail, in order to demonstrate that the structures that we discuss can operate correctly under high-power conditions. Furthermore, comparisons between simulations and measurements of several prototypes are also included, showing an excellent agreement between simulated and experimental data, thereby fully validating both the design approach and the filter reconfiguration strategy.

The purpose of a terminological definition is to represent in natural language the most relevant knowledge associated with a term. However, the knowledge activated by a term (i.e., its meaning) varies according to the usage context. Since context is indispensable in meaning construction, it should guide terminological definition writing. Nonetheless, the recommendation is still that a terminological definition should represent a concept's necessary and sufficient characteristics, which are regarded as context-independent. This paper proposes a parametrization of the contextual constraints applicable to terminological definitions so that context can be accounted for in them. To this end, the notions of premeaning and precontext are introduced, and different types of contextual constraints (linguistic, thematic, cultural, etc.) are discussed. We argue that the conscious application of contextual constraints by the terminologist helps to produce more useful definitions and to avoid inconsistencies and biases.

Abstract Background The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). Methods Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3 −, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. Results We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002–0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01–1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43–3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02–0.18], p

Introducción: Un mortinato, es un evento del embarazo que supone un resultado negativo para padres, familias y personal de salud involucrado. La falta de recursos podría ser el principal obstáculo al acceso de atención prenatal, síntoma de inequidades en salud. El débil conocimiento de causas de mortinatalidad se asocia a la creencia de que son inevitables; sin embargo, muchos factores vinculantes son potencialmente modificables.Objetivo: Describir las causas de mortinatalidad en Chile.Material y métodos: Estudio transversal y analítico. El análisis se precisó desde las 22 semanas gestacionales, según criterio estándar de la Organización Mundial de la Salud. Las causas de mayor frecuencia se utilizaron para determinar asociación mediante test con nivel de significación estadística pResultados: El mayor porcentaje de muertes fetales se registró a las 35 o más semanas (35,63%). Principales macro-causas de mortinatalidad fueron tipo: fetal (47,0%), placentaria (31,4%) y desconocida (10,89%). Principales causas específicas fueron: hipoxia intrauterina (24,4%), causa no especificada (10,87%), y anomalías morfológicas-funcionales placentarias (10,83%). Causa específica hipoxia intrauterina se asocia a edad gestacional, edad materna y nivel educacional materno (pConclusiones: La salud prenatal es reflejo de atención obstétrica, calidad y progreso en atención sanitaria. Existen brechas en detección de causas y calidad de los registros, por lo que las causas desconocidas tiendan al alza en el tiempo. Es recomendable adicionar al registro de muertes fetales componentes temporal, biológico y social maternos.Palabras claves: Mortinatalidad, muerte fetal, inequidades en salud, resultado del embarazo, causas de muerte, factores de riesgo.

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p

BackgroundNumerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL.MethodsA single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months.ResultsSeven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1-21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2-68.2).ConclusionsAlmost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.

Cytomegalovirus (CMV) is a double-stranded DNA virus. It is an opportunistic infection that usually affects individuals with AIDS or with profound immunosuppression. CMV retinitis is the most frequent ocular manifestation. Infrequently, this pathology has been observed in patients undergoing immunosuppressive treatment due to autoimmune diseases. This article presents a case of Crohn's disease with systemic and ocular involvement by CMV after starting treatment with infliximab (anti-tumor necrosis factor-alpha antibody).

Objetivo: Analizar el uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Método: Estudio multicéntrico, observacional y prospectivo. Se reclutaron 672 pacientes mayores de 75 años hospitalizados en Medicina Interna entre abril de 2011 y marzo de 2012. Se utilizaron los criterios Beers, STOPP-START y ACOVE para detectar el uso inadecuado de medicamentos, y los resultados se compararon entre pacientes pluripatológicos y no pluripatológicos. Resultados: De 672 pacientes incluidos, 419 (62%) eran pluripatológicos y el 89,3% de ellos presentaban un uso inadecuado de medicamentos, frente al 79,4% de los no pluripatológicos (p

We report, to our knowledge, the first successful treatment of novel Influenza A (H1N1)/2009 chronic pericardial effusion in an adult. This patient presented on admission respiratory failure and cardiac tamponade which required non invasive ventilation and drainage. Pericardial fluid polymerase chain reaction sequences were positive for Influenza A (H1N1)/2009 virus. Any other etiologies were discarded. Recidivating pericardial effusion after medical treatment, firstly with Oseltamivir, and afterwards, with colchicine and corticosteroids during six months, was solved with pericardiectomy.

Resumen: La coartación de la aorta abdominal es una afección vascular no hereditaria poco frecuente, que afecta a hombres y mujeres por igual. Recientemente ha sido nombrada como “Síndrome aórtico medio”, y los hallazgos clínicos son similares a los de la CoAo típica. Para el diagnóstico, se debe recurrir a la resonancia magnética o a la arteriografía, y las opciones terapéuticas incluyen la dilatación percutánea con catéter-globo, el tratamiento quirúrgico y, por último, como opción más novedosa, la implantación de prótesis endovasculares. En este artículo presentamos el caso de una mujer de 45 años de edad, exfumadora, con antecedentes de artritis reumatoidea e hipertensión arterial que presentaba claudicación de miembros inferiores durante la marcha. Existía una disminución bilateral marcada de los pulsos femorales y el Doppler, y mostró un componente amortiguado en ambas arterias femorales y poplíteas. La AngioTAC encontró una estenosis significativa del tercio distal de la aorta abdominal infrarrenal, con hipoplasia marcada de la ilíaca derecha. La aortografía corroboró el diagnóstico (gradiente de 80 mmHg). A través de dos introductores arteriales por las arterias femorales se avanzaron dos catéteres-globo MATCH-35 de 5.0x80 mm que se inflaron simultáneamente y posteriormente, se implantó un stent MEDTRONIC “Bridge Assurant” de 10 x 30 mm en el segmento estenótico, sin complicaciones. El gradiente residual fue de 10 mmHg. La paciente evolucionó favorablemente y fue egresada a las 24 horas del procedimiento. / Abstract: Coarctation of the abdominal aorta is an uncommon, non-inherited vascular condition that affects men and women alike. It has been recently named as "middle aortic syndrome", and the clinical findings are similar to those of typical aortic coarctation. For diagnosis, one must make use of magnetic resonance imaging or arteriography, and therapeutic options include percutaneous balloon catheter dilatation, surgical treatment and, finally, as a more novel option, the implantation of stents. In this paper we present the case of a 45-year-old female, ex-smoker with a history of rheumatoid arthritis and hypertension who presented claudication of lower limbs during gait. There was a marked bilateral decrease of the femoral and Doppler pulses, and showed a damping factor in both femoral and popliteal arteries. The CT angiography found a significant stenosis of the distal third of the infrarenal abdominal aorta with marked hypoplasia of the right iliac. Aortography confirmed the diagnosis (gradient of 80 mmHg). Using two arterial sheaths, two-balloon catheters MATCH-35, 5.0x80 mm were introduced through femoral arteries, simultaneously inflated and subsequently a MEDTRONIC "Bridge Assurant" stent of 10x30 mm was implanted in the stenotic segment; with no complications. The residual gradient was 10 mmHg. The patient improved and was discharged form the hospital 24 hours after the procedure.

Objetivos: Comparar la satisfacción de los usuarios de 4 hospitales de agudos. Métodos: La población estuvo formada por sujetos que habían sido hospitalizados durante enero y febrero de 2002 en 4 hospitales del Servicio Vasco de Salud-Osakidetza. Se seleccionaron 650 pacientes de cada centro, a quienes se envió un cuestionario de satisfacción compuesto por 34 ítems que se resumen en 6 factores. Se crearon puntuaciones independientes para cada factor. Se compararon las variables sociodemográficas y del episodio, algunas preguntas globales y las puntuaciones medias de los factores en los 4 hospitales. Resultados: Se hallaron diferencias entre los hospitales respecto a la edad, el número de ingresos anteriores, el tipo de servicio, los días de estancia y las preguntas que evaluaban el tiempo de espera desde que el usuario llegó al hospital hasta que fue ingresado. Aunque el grado de satisfacción en general fue alto, se pudieron detectar diferencias en función del hospital y el área evaluados. Así, los usuarios ingresados en el hospital 3 mostraron mayor grado de satisfacción en los factores «información», «trato» y «bienestar», y el grado de satisfacción más bajo en estos factores se detectó en el hospital 1. Los resultados observados en el análisis univariante apenas variaron en el multivariante. Conclusiones: La disponibilidad de un cuestionario de estas características ha permitido obtener resultados comparables entre los hospitales participantes en el estudio, convirtiéndose así en un instrumento que permite detectar áreas de excelencia y de mejora.Objectives: To compare patient satisfaction in 4 acute hospitals. Methods: The sample was composed of individuals admitted to 4 hospitals in the Basque Health Service (Osakidetza, Spain) in January and February 2002. Six hundred and fifty patients were selected from each hospital and were sent a satisfaction questionnaire composed of 34 items summarized in 6 factors. Independent scores for each factor were created. Sociodemographic variables, those related to admission, as well as some global questions and the average scores of the factors were compared among the 4 hospitals. Results: Differences between the 4 hospitals were found in age, the number of previous admissions, type of service, length of hospital stay, and the questions evaluating satisfaction with waiting time between users’ arrival at the hospital and admission. Although the degree of satisfaction was high, differences were detected depending on the factor and the hospital. Thus, «information», «dealings with staff» and «comfort» were rated more highly by users of hospital 3 than by those of hospital 1. The results observed in the univariate analysis changed only slightly in the multivariate models. Conclusions: The questionnaire used allowed comparable results to be obtained among the 4 hospitals participating in this study and identified areas of excellence and areas requiring improvement in each of the centers.

Balance de las aportaciones al arte peruano en el III Congreso Internacional de Barroco Iberoamericano.

La denominación común de "patrimonio cultural", aplicada también -entre otras varias objetividades culturales- a la arquitectura virreinal peruana, tiene para la generalidad de la gente un significado cultural expresado como mera referencia. El objeto reconocido oficialmente como cultural, en este caso la arquitectura virreinal, se califica con relación a una cultura con la que se supone que está identificado y a la que representa, y cuya conservación y decoroso mantenimiento imponen algunas obligaciones jurídicas que pueden ser cumplidas o vulneradas. Es un modo de presentación genérica del objeto considerado como cultura, para que su conocimiento se extienda a círculos cada vez más amplios de actuales o de futuros espectadores. Como pura denominación de efectos jurídicos, el título de patrimonio cultural puede ser otorgado, renovado o anulado sin que se altere en ningún aspecto la inserción del objeto en una determinada cultura.

Se analizan las características de la meningoencefalitis eosinofílica, la cual presenta en sus primeras etapas, una pleocitosis linfocítica que motiva el diagnóstico erróneo de meningoencefalitis viral, como ocurrió en 3 de nuestros 5 casos. La eosinofilia periférica puede orientar el diagnóstico que se confirma con el estudio evolutivo del líquido cefalorraquídeo, al comprobar la conversión eosinofílica. La hipertensión intracraneal ensombrece el pronóstico y, si no es reconocida y tratada precozmente, puede conducir a la muerte. Se expone nuestra observación de 1 caso en el cual la aplicación oportuna del tratamiento antiedema cerebral, antibiótico y antiparasitario, logró la recuperación total, pese a la grave hipertensión intracraneal y la profusión de lesiones comprobadas por la resonancia magnética nuclear.The characteristic of eosinophilic meningoencephalitis which occurs during the first stages with a lymphocytic pleocytosis resulting in a erroneous diagnosis of viral meningoencephalitis as it happened to be in 3 of 5 cases, are analyzed. The peripheral eosinophilia allows for the diagnosis which can be confirmed by the evolutive study of the cerebrospinal fluid when the eosinophilic conversion is proved. Intracranial hypertension overshadows the prognosis which if not recognized and treated early may results in death. Our experience with one case is treatment antibiotics, and antiparasite therapy resulted in the hypertension, and the profusion of lesions evidence by nuclear magnetic resonance.

OBJECTIVE:To describe the prevalence of dementia and subtypes in a general elderly population in northwestern Spain and to analyze the influence of socio-demographic factors. METHODS:Cross-sectional, two-phase, door-to-door, population-based study. A total of 870 individuals from a rural region and 2,119 individuals from an urban region of Valladolid, Spain, were involved. The seven-minute screen neurocognitive battery was used in the screening phase. A control group was included. RESULTS:A total of 2,170 individuals aged 65 to 104 years (57% women) were assessed. There were 184 subjects diagnosed with dementia. The crude prevalence was 8.5% (95% CI: 7.3-9.7). Age- and sex-adjusted prevalence was 5.5 (95% CI: 4.5-6.5). Main subtypes of dementia were: Alzheimer's disease (AD) 77.7%, Lewy Body disease, 7.6% and vascular dementia (VD) 5.9%. Crude prevalences were 6.6% (AD), 0.6% (Lewy Body disease), and 0.5% (VD). Dementia was associated with age (OR 1.14 for 1-year increase in age), female sex (OR 1.79) and the absence of formal education (OR 2.53 compared to subjects with primary education or more). CONCLUSION:The prevalence of dementia in the study population was lower than the most recent estimates for Western Europe. There was a high proportion of AD among all dementia cases and very low prevalence of VD. Old age, female sex, and low education level were independent risk factors for dementia and AD.

No disponible.

No disponible.

Background: We estimate the prevalence of drug injection, the variables associated with having ever injected and the proportion of ever injectors whose first drug injection was for having sex; we describe the first drug injection episode, analyze the drugs most frequently injected and estimate the prevalence of risky injecting behaviors. Methods: The participants were 3387 MSM without a previous HIV diagnosis attending four HIV/STI diagnosis services in Madrid and Barcelona. Lifetime prevalence and prevalence ratios (PRs) by different factors were calculated using Poisson regression models with robust variance. We compared the characteristics of first drug injection episode, lifetime injection and risky injecting behaviors of those whose first injection was for sex (FIS) with those whose was not (non-FIS). Results: Lifetime prevalence of injection was 2.1% (CI 1.7–2.7). In the multivariate analysis, it was strongly associated with having been penetrated by more than five men in the last 12 months (aPR = 10.4; CI 2.5–43.4) and having met most of their partners at private parties (aPR = 7.5; CI 4.5–12.3), and less strongly with other factors. Of those who had ever injected drugs, 81.9% injected for sex the first time they injected drugs (FIS). At first injection, FIS participants had a mean age of 31 years, 62.7% used mephedrone and 32.2% methamphetamine on that occasion. Of this FIS group 39.0% had ever shared drugs or equipment and 82.6% had always shared for sex. Some 30.8% of non-FIS reported having also injected drugs for sex later on. Conclusions: Only two out of a hundred had ever injected, most to have sex and with frequent drug or injecting equipment sharing. Injecting for sex is the most common first episode of drug injection and is the most efficient risky behavior for the transmission of HIV, hepatitis B or C and other blood-borne infections. MSM participating in private parties should be considered a priority group for prevention policies. [ABSTRACT FROM AUTHOR]