[Expectations of relatives of critically ill patients regarding medical information. Qualitative research study]

OBJECTIVE

To determine and analyse the expectations, needs and experiences of relatives of critically ill patients as regards medical information and the level of their understanding. To find keys for improving communication and to draw up best practices in clinical information.

MATERIAL AND METHODS

Qualitative research study through semi-structured interviews carried out in a polyvalent adult intensive care unit (ICU) in a University Hospital.

PARTICIPANTS

relatives of patients who were admitted to the ICU and who were discharged alive from the Unit. Ten interviews were performed taking into account diversification variables such as, type of family relationship with patients, patient age, length of ICU stay, origin, and location at the time of the interview.

RESULTS

The results of the analysis of 10 interviews focused on: the subjective position of the family in the ICU (the agonizing wait), what the ICU represents for the family (surveillance and monitoring of a situation between life and death), perceived care (complete delegation of care), and medical information (what and how they expect and what and how they receive it), as much in the first information (sincerity, hope, delicacy) as in the successive.

CONCLUSIONS

There is divergence between what families expect and what they get as regards medical information. To know the expectations of the families will help to provide higher quality care and more humane treatment in the ICU.

Co-digestion of cattle manure with food waste and sludge to increase biogas production

Anaerobic co-digestion strategies are needed to enhance biogas production, especially when treating certain residues such as cattle/pig manure. This paper presents a study of co-digestion of cattle manure with food waste and sewage sludge. With the aim of maximising biogas yields, a series of experiments were carried out under mesophilic and thermophilic conditions using continuously stirred-tank reactors, operating at different hydraulic residence times. Pretreatment with ultrasound was also applied to compare the results with those obtained with non-pretreated waste. Specific methane production decreases when increasing the OLR and decreasing HRT. The maximum value obtained was 603 LCH(4)/kg VS(feed) for the co-digestion of a mixture of 70% manure, 20% food waste and 10% sewage sludge (total solid concentration around 4%) at 36°C, for an OLR of 1.2g VS/L day. Increasing the OLR to 1.5g VS/L day led to a decrease of around 20-28% in SMP. Lower methane yields were obtained when operating at 55°C. The increase in methane production when applying ultrasound to the feed mixtures does not compensate for the energy spent in this pretreatment.

Leucaena species valoration for biomass and paper production in 1 and 2 year harvest

In order to identify faster-growing non-woody species usable for biomass and paper production, four Leucaena species (L.diversifolia, L. colinsii, L. salvadorensis and three varieties of L. leucocephala) were tested. All the Leucaena species showed a good soil and climatic adaptation to Spain Southwest except for L. salvadorensis. Studied Leucaena species showed biomass productivity ranges from 67.14 to 9.44 t ha(-1) (o.d.b.) and 43.6 to 11.4 t ha(-1) under Mediterranean conditions for the first and second year sprouts, respectively. The quantity of solubles and extractives shows similar values when compared with wood materials. Relatively lower lignin content in Leucaena (from 15.7% to 21.4%) species has been found with respect to other vegetal species. The alpha-cellulose contents (39.4-45.3%) are in the range of the normal values expected for the other non-wood raw materials. The study confirms the feasibility of organocell yield pulping process to Leucaena species. Organocell process provides an efficient delignification (kappa number 12.4 and pulp yield 42.2%) for L. leucocephala and suitably physical characteristics of paper sheet (tensile index 20.3 kNm/kg for L. diversifolia).

The use of Tagasaste (Chamaecytisus proliferus) from different origins for biomass and paper production

In order to identify faster-growing non-woody species usable for biomass and paper production, four Tagasastes (Chamaecytisus proliferus) from different origins are tested. All the Tagasaste species (T. Huelva, T. Australia, T. New Zealand and T. La Palma island) show a good soil and climatic adaptation to Southwest Spain. The studied Tagasaste provenances shows biomass productivity ranges from 1.0 t ha(-1)yr(-1) to 3.4 th a(-1)yr(-1) (o.d.b.) and 25.3 t ha(-1)yr(-1) to 49.4 t ha(-1)yr(-1) under Mediterranean conditions for first and second year sprouts, respectively. The quantity of solubles and extractives shows similar values when compared with wood materials. A relatively lower lignin content in Tagasaste (from 13.7% to 17.1%) species has been found with respect to other vegetal species. The alpha-celullose contents (43.6-45.3%) were in the range of the normal values expected for the other non-wood raw materials. The study confirms the feasibility of the organocell yield pulping process to Tagasaste provenances. Organocell processes provide an efficient delignification (kappa index from 7.2 to 10.9 and pulp yield from 43.6% to 54.1%). The best results are obtained for the physical properties of paper sheets for Tagasaste from Australia in the second year, with values of tensile index of 16.0 kNm/kg, burst index of 1.12 MPa m2/kg and tear index of 0.55 Nm2/kg.

New-onset hypertension and inflammatory response/poor outcome in acute ischemic stroke

OBJECTIVE

To study the association of previously unknown high blood pressure (HBP) during the acute phase of stroke (new-onset hypertension) with the inflammatory response and clinical outcome.

METHODS

We classified 844 patients with hemispheric ischemic stroke into three groups according to history of hypertension and presence of HBP within the first 24 hours after symptom onset: Group I (n = 412), normotensive patients; Group II (n = 265), chronic hypertensive patients; and Group III (n = 167), new-onset hypertensive patients. Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and metalloproteinase 9 (MMP-9) were measured in blood samples obtained on admission. The influence of new-onset HBP and markers of inflammation on poor neurologic outcome at 3 months was evaluated by logistic regression analysis.

RESULTS

New-onset HBP was found in 19.9% of patients. Patients in this group had higher plasma concentrations of IL-6, TNF-alpha, ICAM-1, VCAM-1, and MMP-9 than the other two groups. New-onset HBP was associated with poor outcome at 3 months (odds ratio [OR] 2.10; 95% CI 1.54 to 3.52; p < 0.0001) after adjustment for other prognostic factors. However, when markers of inflammation were included in the model, IL-6 (OR 1.01; 95% CI 1.00 to 1.03; p = 0.020) and MMP-9 (OR 1.01; 95% CI 1.00 to 1.01; p < 0.0001), but not new-onset HBP, were independently associated with poor neurologic outcome.

CONCLUSIONS

New-onset high blood pressure in acute ischemic stroke, but not chronic hypertension, is associated with an inflammatory response and poor neurologic outcome.

Chagas disease in bone marrow transplantation: an approach to preemptive therapy

The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

Prognostic value of tumoral ploidy in a series of spanish patients with acute lymphoblastic leukemia

The prognostic value of tumoral ploidy and its relation with nonrandom chromosome alterations were analyzed in 89 cases of acute lymphoblastic leukemia. Ploidy is associated with the number of nonrandom chromosome alterations and survival. The pseudodiploid and hypodiploid groups had a high incidence of nonrandom alterations and poor survival while the diploid and high hyperdiploid groups had a lower incidence of nonrandom alterations and longer survivals. The patients in the low hyperdiploid group with random alterations received the same treatment as the diploid and high hyperdiploid groups but had poor survivals. Our analysis confirms that ploidy is a very important prognostic factor and suggests that patients with low hyperdiploidy should receive intensive therapies similar to those of patients in the groups with a high number of nonrandom alterations.

[Phenotypes of macrolide, lincosamide, and streptogramin resistant Streptococcus viridans isolated from blood]

Macrolide resistance has been widely studied in Streptococcus pyogenes and Streptococcus pneumoniae although not in viridans group streptococci (VGS). We studied 30 blood culture isolates of viridans group streptococci (25 resistant to erythromycin: 10 S. mitis, 8 S. milleri, 6 S. sanguis and 1 S. salivarius; and 5 susceptible: 2 S. mitis, 2 S. milleri and 1 S. sanguis). We carried out a double-disk test and determined MICs. The susceptibility testing was carried out by agar dilution for 14-, 15- and 16-member lactone ring macrolides, as well as for clindamycin and quinupristin-dalfopristin. Fifty-six percent of the erithromycin-resistant strains (6 S. mitis, 6 S. milleri and 2 S. sanguis) showed an MLS(B) phenotype, with a high level of intrinsic resistance to all the macrolides studied and clindomycin; 28&#37; were of the M phenotype (4 S. sanguis, 2 S. mitis and 1 S. salivarius). We found a third resistance phenotype, which was present in 4 strains with MICs of 2-8 microg/ml, with resistance to macrolides and different degrees of resistance to clindamycin. All isolates were fully susceptible to quinupristin-dalfopristin. The MLS(B) and M phenotypes initially described in S. pyogenes and S. pneumoniae are also observed in VGS.

Involvement of nitric oxide in protecting mechanism during experimental cryptococcosis

In the present study we investigated the role of nitric oxide (NO) in the effector mechanisms of host defense against Cryptococcus neoformans in vivo. Our results showed an increase of NO produced by the peritoneal macrophages from 14-days infected rats compared with normal rats. These cells were capable of killing C. neoformans to a greater extent than macrophages from noninfected rats (80% vs 20%, respectively). The killing of C. neoformans by infected cells was efficiently inhibited (80% to 35%, P < 0.001) by adding aminoguanidine (AG) to the cultures. We observed that in vivo administration of AG to the infected animals efficiently inhibited the metabolism producing NO and failed to affect that of normal animals. When the NO synthase (NOS) was inhibited in vivo in the infected animals, a marked increase of the fungi charge in the organs was observed with respect to the normal animals treated with AG. We also observed that the course of the infection is drastically modified after the inhibition of NO production because all the animals infected and treated with AG died from cryptococcosis before 20 days postinfection (p.i.). These results indicate that NO is a crucial molecule in the effector mechanisms in this infection model.

Translational diffusion and intrinsic viscosity of globular proteins. Theoretical predictions using hydrated hydrodynamic models. Application to BPTI

In this paper, we present a way to make hydrodynamic models of globular proteins, including the hydration shell associated with them in aqueous solutions. Theoretical calculations using these models are made in order to determine the hydrodynamic properties of these proteins, employing rigorous and approximate methods of calculation. These will be applied to the bovine pancreatic trypsin inhibitor, BPTI. Several hydrodynamic models are constructed: the A-model for the unhydrated protein BPTI and a set of H-models for hydrated protein with different hydration degrees. Theoretical results for the translational diffusion coefficient Dt and the intrinsic viscosity [eta] are obtained from different models. From the analysis of the A-model and hydrodynamic properties, there is not a clear assignation of an ellipsoidal shape to this protein molecule. An amount of approximately 0.5 g H2O/g protein could be assigned to the BPTI.

Learning deficits produced by chronic and reversible lesions of the corpus striatum in rats

In a first experiment it was found that the reversible disruption of the normal activity of the corpus striatum (CN) of rats by microinjections of potassium chloride produced a marked impairment on the acquisition of a one-trial passive avoidance task. Two additional experiments showed the same performance deficits on the acquisition as well as on the retention of the task when the CN was electrolytically lesioned. Since two different methods of disrupting the functional integrity of the striatum were used, it can be concluded that the results are not due to the pecularities of a single method. These results further support the hypothesis of critical involvement of the CN in the integration and storing of learned information.