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Bleeding is the most common preventable cause of death in trauma patients. Acute traumatic coagulopathy is a specific condition with a different pathophysiology from other causes of the massive bleeding. An early identification of the coagulopathy is fundamental to implementing rapid treatment. There have been many changes in the management of massive hemorrhage, for example, the administration of the tranexamic acid and the use of balanced transfusion ratio. This review presents these practical points, some of them with scientific evidence, in order to achieve a beneficial effect for patient outcomes.

Dissertação de mestrado integrado em Arquitectura (área de especialização em Cultura Arquitetónica), Esta dissertação propõe um estudo das Representações de Futuro da Cidade e da Casa, a partir do Cinema. São exploradas diferentes visões utópicas que influenciaram a transformação da sociedade, como consequência a cidade e a casa, ao longo do século XX e início do século XXI. O Cinema surge como uma manifestação do desenvolvimento tecnológico da Revolução Industrial e tornou-se o paradigma da modernização, passando por diferentes processos de transformação associado ao desenvolvimento da civilização e da tecnologia. A partir das relações entre a cidade e a casa, são analisadas as visões arquitetónicas projetadas em filmes que especulam o futuro transformando a arquitetura em protagonista. São analisados 3 filmes de diferentes épocas, utilizando um texto de um Arquiteto como referência, que se pensa corresponder à temática abordada no filme. O primeiro capítulo Things to Come, de H. G. Wells, de 1936 aborda uma visão de progresso positivista influenciada pela evolução das máquinas durante a Revolução Industrial, abordando conceitos de transparência e imaterialidade. Apoiase no texto “Ineffable Space” de Le Corbusier para contextualizar a temática. O segundo capítulo THX 1138, de George Lucas, de 1971 apresenta o controlo feito pela tecnologia, onde a arquitetura é apresentada com uma lógica de interiorização. Vários teóricos e arquitetos começam a rever os ideais da Arquitetura Moderna, abrindo a perceção do que representa a Arquitetura, apoiando-se no poema “The love is gone” de David Greene. O último capítulo Her, de Spike Jonze, de 2013, apresenta uma sociedade governada pela tecnologia que provocou que a cidade e a casa se tornassem em espaços genéricos e sem identidade. Sustentado com o texto “Generic City” de Rem Koolhaas de 1995., This thesis proposes a study of the Representations of the Future of the City and Dwelling, through Cinema. It’s based on different utopian visions that have influenced the transformation of society, consequently the city and dwellings, throughout the 20th century and the beginning of the 21st century. Cinema appears as a manifestation of the technological development of the Industrial Revolution and has become the paradigm of modernization, going through different processes of transformation associated to the development of civilization and technology. Bearing in mind the link between city and dwelling, the architectural visions projected in films that conjecture the future will be analyzed, turning architecture into protagonist. Three films from different periods will be analyzed, having a text by an Architect as a reference, that is believed to correspond to the theme of the film. The first chapter Things to Come, produced by H. G. Wells, in 1936, addresses an positivist vision of progress influenced by the evolution of machinery during the Industrial Revolution, focusing on concepts of transparency and immateriality. It is based on the article “Ineffable Space” by Le Corbusier. The second chapter, THX 1138, produced by George Lucas, in 1971, displays the control made by technology, where architecture is presented in an interiorized logic. Several architects and theorists start to reconsider the Modern Architecture ideals, expanding the perception of what Architecture represents, supported by David Greene’s poem “The love is gone”. The last chapter scrutinizes Spike Jonze’s movie Her, from 2013, which features a society governed by technology, which transformed the city and the dwelling in generic and characterless spaces. It’s supported by Rem Koolhaas text “Generic City”.

Bleeding is the most common preventable cause of death in trauma patients. Acute traumatic coagulopathy is a specific condition with a different pathophysiology from other causes of the massive bleeding. An early identification of the coagulopathy is fundamental to implementing rapid treatment. There have been many changes in the management of massive hemorrhage, for example, the administration of the tranexamic acid and the use of balanced transfusion ratio. This review presents these practical points, some of them with scientific evidence, in order to achieve a beneficial effect for patient outcomes.

SummaryEfficacy and tolerability of tiagabine was evaluated in patients with non-controlled partial seizures in a multicentre, open-label, parallel group study. Tiagabine was administered either two (b.i.d.) or three times daily (t.i.d.) as adjunctive therapy and titrated stepwise to a target of 40mg/day during a 12-week, fixed-schedule titration period; this was followed by a 12-week flexible continuation period. The primary efficacy endpoint was the proportion of patients completing the fixed-schedule titration period. A total of 243 patients were randomised and received treatment, 123 to b.i.d. and 120 to t.i.d. dosing. Fewer patients in the b.i.d. (76 and 62%) than in the t.i.d. (87 and 72%) group completed the fixed-schedule titration period (OR: 0.562; 95% CI: 0.309–1.008; P=0.0532). The median percentage decrease in all types of seizure (excluding status epilepticus) during the fixed schedule titration period was 33.4% for the b.i.d. and 23.8% for the t.i.d. groups (P=0.9634; Van Elteren's test). The proportion of responders was similar for the b.i.d. and t.i.d. groups. There were no significant differences between dosage regimens in the change in median seizure rates from baseline. Adverse events were more frequent during the titration than the continuation period. Most events were mild and related to the central nervous system. Although their incidence was similar between treatment groups, severity was more frequent in the b.i.d. group. Our results suggest that during titration tiagabine is better tolerated with t.i.d. dosing, but during long-term maintenance, a t.i.d. schedule is as effective and well tolerated as b.i.d.

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.

To evaluate Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) in non-diabetic subjects, according to obstructive sleep apnoea syndrome (OSAS) severity and the associations of these indices with anthropometric characteristics and parameters of breathing function during sleep.We included 610 non-diabetic subjects with suspected OSAS, evaluated by polysomnography. According to their apnoea-hypopnoea index (AHI), patients were divided into Group A (n=148) with AHI5/h; Group B (n=121) with AHI: 5-14.9/h; Group C (n=85) with AHI: 15-29.9/h and Group D (n=256) with AHI ≥ 30/h. MPV and PDW were measured using an automated blood cell counter.MPV was significantly higher in group D (mean value 12.1 ± 1.3 fl) than in groups A (9.8 ± 1.1 fl), B (9.8 ± 1.6 fl), and C (11.5 ± 1.3 fl) (p0.001). The same pattern was observed in PDW values (15.9 ± 2.2 fl for group D and 13.2 ± 2.2 fl for group A, 14.1 ± 2.8 fl for group B, and 15 ± 2.2 fl for group C, p0.001). Significant correlations were seen between MPV and AHI (p0.001), average pulse oxygen saturation (SpO(2)) (p0.001), minimum SpO(2) (p0.001) and percent of the total sleep time with SpO(2) lower than 90% (t90%) (p0.001) during sleep, Arousal Index (p0.001) and Epworth sleepiness scale (ESS) (p=0.028). Similarly, PDW was correlated with AHI (p0.001), average SpO(2) (p=0.001), minimum SpO(2) (p0.001), t90% (p=0.002), and Arousal Index (p0.001).MPV and PDW are higher in non-diabetic patients with severe OSAS and are correlated with different parameters of breathing function during sleep.

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.

We describe a series of 16 cases in which recombinant activated factor VII (rFVIIa) was used in our postanesthetic recovery unit. The mean age of the patients was 53.5 years (range, 30-84 years). Eleven were men and 5 women. The mean dose of rFVIIa used was 75 microg x kg(-1) (range, 60-90 microg x kg(-1)) and 25% of the patients needed a second dose. All the patients had postoperative bleeding, 62.5% after general surgery, 25% after a liver transplant, and 12.5% after a lung transplant. rFVIIa therapy was effective in 66% of the patients and no adverse thrombotic events related to treatment were observed. rFVIIa can be an efficacious therapeutic option for bleeding and coagulation disorders that are refractory to conventional replacement therapy. Approval to use rFVIIa in this setting and the establishment of indications should be based on further research.

The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy.A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines.The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy.A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines.The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy.A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines.The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

The objective of this work was to produce a scientific evidence-based guide to clinical practice dealing with the basic questions concerning the treatment of epilepsy.A committee of 11 experts belonging to the Andalusia Epilepsy Society, made up of six neurologists, three neuropaediatricians, one neurosurgeon and a pharmacologist, all of whom were deeply involved and experienced in epilepsy, conducted a thorough review of the literature in search of all the evidence available on the proposed subject matter. The following databases were used: MEDLINE, Cochrane Library and the databases of several clinical practice guidelines (National Guideline Clearinghouse, National Institute of Clinical Excellence and the American Academy of Neurology's Clinical Guidelines). The Guide was set out in seven sections and was published in four parts. From a total number of 187 relevant documents, the committee found 63 examples of scientific evidence and 91 therapeutic recommendations. These were tabulated and classified according to the European Federation of Neurological Societies' criteria for producing Clinical Practice Guidelines.The results of this survey provide scientific evidence-based clinical guidelines that are useful, simple and applicable at different levels of health care.

A 35-year-old woman was scheduled for laparoscopic removal of an ovarian tumor. Intravenous metamizol was administered and when pneumoperitoneum was performed she developed severe hypotension and bronchospasm. Anaphylactic reaction was suspected, all drugs were suspended, and 2 doses of intravenous adrenalin (0.2 and 1 mg) were injected followed by continuous perfusion. Because response was slow and given the unknown origin of the tumor, the possibility of a carcinoid crisis was considered. When an intravenous bolus dose of octreotide was administered, pressure recovered, patient was extubated and could be transferred asymptomatic to the recovery ward. Tests later ruled out carcinoid syndrome, whereas tryptase levels in blood extracted during surgery and allergy tests confirmed an anaphylactic reaction to metamizol. Carcinoid crisis can be difficult to distinguish from anaphylactic reaction because the clinical pictures are similar. Anesthetic management of carcinoid crisis has been facilitated by administration of octreotide. Less is known about the use of octreotide to treat hypotension in patients with autonomic neuropathy based mainly on the drug's ability to produce splanchnic vasoconstriction. This is probably the reason why octreotide resolved our patient's shock in a context of systemic vasodilation caused by the anaphylactic reaction.

To review the present knowledge related with gender differences in drug effects, with special emphasis concerning antiepileptic drugs (AEDs).Women and men differ in their response to drugs and these differences can be sometimes clinically relevant. Adverse drug reactions are noticeably more frequent in women, probably due to a combination of cultural and biological factors. Gender differences related to antiepileptic treatment have been observed concerning alterations in bone mineral density and lipid profile due to several AEDs, lamotrigine induced rash and visual field loss caused by vigabatrin. It is also important to study potential drug interactions between AEDs and contraceptives, as well as hormonal replacement therapy (HRT). At this respect, the influence of AEDs on the pharmacokinetics and efficacy of contraceptives are well known, but no data are available concerning the effect of contraceptives on AEDs pharmacology. Likewise, data relative to the eventual interactions arising between HRT and anticonvulsant are lacking.The knowledge about gender differences in the adverse drug reactions and interactions of AEDs is still limited; more information is necessary to optimize anticonvulsant treatment in epileptic women.

The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied.To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure.We studied the patients with non traumatic rhabdomyolysis (creatinkinase1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others.We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%.CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.

Tiagabine is a new antiepileptic drug which acts by blocking neuronal and glial GABA uptake and it is indicated in the treatment of partial epilepsies. Its pharmacokinetics is lineal, being extensively metabolized in the liver by means of CYP3A4 isoenzyme. Plasma elimination half life ranges between 5-8 hours in healthy volunteers, being markedly reduced when the drug is administered concomitantly with enzyme-inducing antinconvulsants. Tiagabine does not induce nor inhibit hepatic enzymes and, consequently, it does not modify the kinetics of simultaneously prescribed antiepileptic drugs. No relevant kinetic differences have been observed between adults and elderly subjects. Renal impairment does not alter the pharmacokinetic profile of tiagabine; hepatic disease, however, significantly reduces tiagabine elimination and lower daily doses of the drug are necessary in these patients. Although tiagabine elimination half life is short, it has been ascertained that therapeutic efficacy is similar when administered in 2 or 4 divided doses. Tiagabine is usually well tolerated; its most frequent side effects include dizziness, asthenia, nervousness, tremor, diarrhea and depressed mood.

GABA is the major inhibitory neurotransmitter in the brain. It is synthesized by the action of glutamic decarboxylase on glutamate and preferently metabolized by the action of GABA transaminase; it experiences neuronal and glial uptake mediated by four types of highly selective transporters.The hypothesis that abnormalities in GABAergic function can be involved in the physiopathology of epilepsy, specially those of partial origin, is supported by data from proceeding from experimental and human epilepsies, as well as by the fact that agents that inhibit GABAergic function exert a proconvulsant action whereas gabaergic agents frequently act as anticonvulsant. On the last years, therefore, substances with gabaergic activity have been investigated as potential antiepileptic drugs.Tiagabine, a nipecotic acid derivative, selectively inhibits GABA neuronal and glial uptake by blocking one of its transporters. Its antiepileptic activity has been assessed in different experimental model and it is currently used in the clinical treatment of partial epilepsies.

We report experiments that demonstrate the non-invasive measurement of lacquer coating thickness using a thermal wave timing technique.

Introduccion. Aunque los radicales libres son mediadores importantes en la regulacion de algunos procesos celulares, pueden causar citotoxicidad cuando se producen en exceso o las defensas antioxidantes disminuyen, y se han implicado en la patogenia de numerosas enfermedades. Asimismo, los farmacos, fundamentalmente a traves de la produccion de metabolitos intermediarios, pueden aumentar el estres oxidativo; en este sentido, diversos autores han observado alteraciones del metabolismo oxidativo en pacientes epilepticos tratados. Objetivo. Evaluar la susceptibilidad a la peroxidacion lipidica en epilepticos adultos tratados con acido valproico (VPA), y comprobar si esta guarda relacion con la concentracion plasmatico del farmaco, el sexo del enfermo o el tipo de epilepsia padecido. Pacientes y metodos. Los lipidos peroxidados (LPO) se midieron mediante espectrofluorometria antes y despues de la induccion de una reaccion oxidativa de tipo Fenton en el plasma de 76 pacientes epilepticos y 48 sujetos sanos. Resultados. La formacion de LPO tras la oxidacion mostro una relacion lineal positiva con las concentraciones plasmaticas de VPA. Asimismo, fue superior en los pacientes con epilepsias parciales que en aquellos con epilepsias generalizadas. Se observo tambien un efecto significativo del sexo, puesto que los valores de LPO se elevaron mas en las mujeres que en los varones epilepticos. Conclusiones. En el plasma de los pacientes tratados con VPA se aprecia una vulnerabilidad al estres oxidativo directamente proporcional a la concentracion plasmatica del farmaco, mas acentuada en las mujeres que en los hombres. Esta, por otra parte, parece ser mayor en los pacientes con epilepsias parciales.

1. The relationship between plasma concentrations and cardiac effects of nortriptyline was studied in anaesthetized young and old rats. 2. Nortriptyline was administered by two consecutive intravenous infusions which resulted in a peak plasma concentration followed by steady state values. Increasing infusion rates were followed by proportional increases in the drug plasma concentrations ranging from 0.15 to 6.0 microgram/ml. 3. In young rats, nortriptyline induced an increase in the heart rate, a right rotation of the electrical axis and a prolongation of the PQ interval. Heart rate changes were not correlated with nortriptyline plasma concentrations, while significant correlations were found for the other two parameters. Plasma concentrations inducing 20% increase of the PQ interval and 40 degrees rotation of the electrical axis were 1.65 microgram/ml respectively. Arrhythmias occurred at concentrations higher than 5.2 microgram/ml. 4. Nortriptyline caused more severe cardiac effects in old than in young animals. However, plasma concentrations of nortriptyline in old rats were two to five times higher than those found in young rats at similar infusion rates. A higher concentration of the drug at its sites of action seems to be responsible for the more severe cardiac toxicity of nortriptyline observed in old rats.

Gentamicin therapy was monitored in 30 patients with severe infection and other concomitant disease states. The application of the nomogram of Hull and Sarubbi [6] produced good plasma levels and disappearance of the infective agent without evidence of drug toxicity in 70% of patients. The remaining 30% did not respond satisfactorily to the treatment and showed low drug serum concentrations; all of them had heavy fluid losses; when we modified their treatment, outside of the nomogram guidelines, we observed a better response. Since gentamicin distributes essentially in extracellular water, subjects who have alterations of body fluids regulation should be carefully controlled.

The pharmacokinetic and clinical efficacy of three theophylline slow-release formulations was studied in 29 children suffering chronic bronchial asthma. Theophylline loading dose was of 6 mg/kg; maintenance dose was adjusted according to therapeutic effect and drug plasma concentrations and ranged to 11.1 to 31.3 mg/kg/daily (means = 22.32 +/- 6.6 mg/kg/daily). Peak theophylline plasma levels were 13.38 +/- 4.83 micrograms/ml and through plasma levels were 8.73 +/- 3.78 micrograms/ml. No difference was found among theophylline formulations for clinical response nor kinetic parameters. Drug plasma half-life varied from 2.9 to 18.2 hr (means = 8.85 +/- 3.64 hr). Theophylline total body clearance and apparent volume of distribution exhibited a marked decrease during chronic drug administration in relation to the values observed after intake of the loading dose. Twenty three of the children reached a good degree of control of bronchospasm and did not require any associated medication.