Does bariatric surgery improve the patient's quality of life?

Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS) on the quality of life (QoL), applying the Nottingham Health Profile (NHP) and the bariatric analysis and reporting outcome system (BAROS). Design: A prospective cohort study was performed in 100 adult patients (> 18 years) undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI) was 50.7 kg/m2. Results: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p < 0.001) with respect to baseline values. According to the BAROS test, 48% of patients lost 25-49% of weight excess and 80.8% had resolved major comorbidities at 1 yr. According to the Moorehead-Ardelt QoL score, there were major improvements in employment and self-esteem in 89% and 87% of patients, respectively, and improvements in physical activity, sexual and social relationships. According to the total mean BAROS score, the outcome was considered “very good”. Conclusion: NHP and BAROS questionnaires appear to be useful and easily applicable tools to assess the QoL of obese patients.

Demyelination induced by protein kinase C-activating tumor promoters in aggregating brain cell cultures.

The plasticity of mature oligodendrocytes was studied in aggregating brain cell cultures at the period of maximal expression of myelin marker proteins. The protein kinase C (PKC)-activating tumor promoters mezerein and phorbol 12-myristate 13-acetate (PMA), but not the inactive phorbol ester analog 4alpha-PMA, caused a pronounced decrease of myelin basic protein (MBP) content and 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNP) activity. In contrast, myelin/oligodendrocyte protein (MOG) content was affected relatively little. Northern blot analyses showed a rapid reduction of MBP and PLP gene expression induced by mezerein, and both morphological and biochemical findings indicate a drastic loss of compact myelin. During the acute phase of demyelination, only a relatively small increase in cell death was perceptible by in situ end labeling and in situ nick translation. Basic fibroblast growth factor (bFGF) also reduced the levels of the oligodendroglial differentiation markers and enhanced the demyelinating effects of the tumor promoters. The present results suggest that PKC activation resulted in severe demyelination and partial loss of the oligodendrocyte-differentiated phenotype.

Proceso trastornos del espectro autista : proceso asistencial integrado

Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

Síndrome coronario agudo sin elevación de ST (SCASEST) : angina inestable e infarto sin elevación de ST (AI/IAMNST) : proceso asistencial integrado

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

Energy cost of glucose storage in human subjects during glucose-insulin infusions.

The effect of graded levels of hyperinsulinemia on energy expenditure, while euglycemia was maintained by glucose infusion, was examined in 22 healthy young male volunteers by using the euglycemic insulin clamp technique in combination with indirect calorimetry. Insulin was infused at five rates to achieve steady-state hyperinsulinemic plateaus of 62 +/- 4, 103 +/- 5, 170 +/- 10, 423 +/- 16, and 1,132 +/- 47 microU/ml. Total body glucose uptake during each of the five insulin clamp studies was 0.41, 0.50, 0.66, 0.74, and 0.77 g/min, respectively. Glucose storage (calculated from the difference between total body glucose uptake minus total glucose oxidation) was 0.25, 0.29, 0.43, 0.49, and 0.52 g/min for each group, respectively, and represented over 60-70% of total glucose uptake. The net increment in energy expenditure after intravenous glucose was 0.08, 0.10, 0.14, 0.17, and 0.23 kcal/min, respectively. Throughout the physiological and supraphysiological range of insulinemia, there was a significant relationship (r = 0.95, P less than 0.001) between the increment in energy expenditure and glucose storage, indicating an energy cost of 0.45 kcal/g glucose stored. However, at each level of hyperinsulinemia, the theoretical value for the energy cost of glucose storage (assuming that all of the glucose is stored in the form of glycogen) could account for only 45-63% of the actual increase in energy expenditure that was measured by indirect calorimetry. These results indicate that factors in addition to glucose storage as glycogen must be responsible for the increase in energy expenditure that accompanies glucose infusion.

Changes in health related quality of life 3 months after an acute coronary syndrome

BACKGROUND The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes. METHODS HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable. RESULTS There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors. CONCLUSION The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.

A validated clinical approach for the management of aspergillosis in critically ill patients: ready, steady, go!

The clinical relevance of recovering Aspergillus species in intensive care unit patients is unknown. Diagnosis of invasive pulmonary aspergillosis is extremely difficult because there are no specific tests sensitive enough to detect it. The rapidly fatal prognosis of this infection without treatment justifies early antifungal therapy. A clinical algorithm may aid clinicians to manage critically ill patients from whose respiratory specimens Aspergillus spp. have been isolated. This new tool needs to be validated in a large cohort of patients before it can be recommended.

Militarism and Melodrama: The Cultural Work of Combat Death

This essay examines the role of melodrama in the American war film, focusing on three post-WWII examples. The main argument centers on the natural alliance between melodrama and militarism based on a shared intolerance for the notion of death as meaningless and in vain. Both melodrama and military ideology employ elaborate rhetorical and narrative strategies to enfold deaths into larger systems of meaning, such as the nation, or in more personal terms, as a rite of passage. One of the most common narrative devices present in the military melodrama is the death that converts survivors to the values of the virtuous victim. The essay examines the shared conventions and different strategies of the following three films: Sands of Iwo Jima (1949), Platoon (1986), and Top Gun (1986).

Gefitinib in Combination With Irradiation With or Without Cisplatin in Patients With Inoperable Stage III Non-Small Cell Lung Cancer: A Phase I Trial.

Purpose : To establish the feasibility and tolerability of gefitinib (ZD1839, Iressa) with radiation (RT) or concurrent chemoradiation (CRT) with cisplatin (CDDP) in patients with advanced non small cell lung cancer (NSCLC).Patients and Methods : In this multicenter Phase I study, 5 patients with unresectable NSCLC received 250 mg gefitinib daily starting 1 week before RT at a dose of 63 Gy (Step 1). After a first safety analysis, 9 patients were treated daily with 250 mg gefitinib plus CRT in the form of RT and weekly CDDP 35 mg/m(2) (Step 2). Gefitinib was maintained for up to 2 years until disease progression or toxicity.Results : Fourteen patients were assessed in the two steps. In Step 1 (five patients were administered only gefitinib and RT), no lung toxicities were seen, and there was no dose-limiting toxicity (DLT). Adverse events were skin and subcutaneous tissue reactions, limited to Grade 1-2. In Step 2, two of nine patients (22.2%) had DLT. One patient suffered from dyspnea and dehydration associated with neutropenic pneumonia, and another showed elevated liver enzymes. In both steps combined, 5 of 14 patients (35.7%) experienced one or more treatment interruptions.Conclusions : Gefitinib (250 mg daily) in combination with RT and CDDP in patients with Stage HI NSCLC is feasible, but CDDP likely enhances toxicity. The impact of gefitinib on survival and disease control as a first-line treatment in combination with RT remains to be determined. (C) 2011 Elsevier Inc.

Estrategia 'Al lado' con...

'Al lado' con ... ha desarrollado las siguientes estrategias: 'Al lado' con las personas afectadas con Alzheimer; 'Al lado' con las personas afectadas por una Enfermedad Mental Grave; 'Al lado' con las personas afectadas por Esclerosis Lateral Amiotrófica; 'Al lado' con las personas afectadas con otros procesos; INFA 'Al lado', con los menores afectados por enfermedades crónicas.

Horae ad usum Parisiensem.

F. 1 Calendrier avec saints parisiens. F. 14 Extraits des IV Évangiles. F. 21v Prières à la Vierge : « Obsecro te... », etc. F. 26 Heures de la Vierge, incompl. (usage de Paris). F. 97 Psaumes de la pénitence. F. 110 Litanies. F. 115 et 124 Heures de la Croix et du Saint-Esprit. F. 132 Office des morts (usage de Paris). F. 180 Les XV joies de la Vierge (en français). F. 186 Les VII requêtes à N.-S. (en français). F. 189 Prière à la Croix (en vers français).

El modelo de activos, clave para la mejora de la salud y el bienestar

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Basic life support teaching in the second year pregraduate medical curriculum: quality of acquisition after 6 months

Purpose of the study: Basic life support (BLS) and automated externaldefibrillation (AED) represent important skills to be acquired duringpregraduate medical training. Since 3 years, our medical school hasintroduced a BLS-AED course (with certification) for all second yearmedical students. Few reports about quality and persistence over timeof BLS-AED learning are available to date in the medical literature.Comprehensive evaluation of students' acquired skills was performedat the end of the 2008 academic year, 6 month after certification.Materials and methods: The students (N = 142) were evaluated duringa 9 minutes «objective structured clinical examination» (OSCE) station.Out of a standardized scenario, they had to recognize a cardiac arrestsituation and start a resuscitation process. Their performance wererecorded on a PC using an Ambuman(TM) mannequin and the AmbuCPR software kit(TM) during a minimum of 8 cycles (30 compressions:2 ventilations each). BLS parameters were systematically checked. Nostudent-rater interactions were allowed during the whole evaluation.Results: Response of the victim was checked by 99% of the students(N = 140), 96% (N = 136) called for an ambulance and/or an AED. Openthe airway and check breathing were done by 96% (N = 137), 92% (N =132) gave 2 rescue breaths. Pulse was checked by 95% (N=135), 100%(N = 142) begun chest compression, 96% (N = 136) within 1 minute.Chest compression rate was 101 ± 18 per minute (mean ± SD), depthcompression 43 ± 8 mm, 97% (N = 138) respected a compressionventilationratio of 30:2.Conclusions: Quality of BLS skills acquisition is maintained during a6-month period after a BLS-AED certification. Main targets of 2005 AHAguidelines were well respected. This analysis represents one of thelargest evaluations of specific BLS teaching efficiency reported. Furtherfollow-up is needed to control the persistence of these skills during alonger time period and noteworthy at the end of the pregraduatemedical curriculum.

Les hépatectomies majeures : mortalité, morbidité et facteurs de risque

RESUME L'objectif de ce travail est de rappeler l'historique des hépatectomies majeures, les bases anatomiques et les techniques opératoires de la chirurgie du foie. Puis, à partir de 212 cas d'exérèses majeures recencées entre 1992 et 2001 dans le service de Chirurgie Viscérale du CHUV, les facteurs de risques, la mortalité et la morbidité des hépatectomies majeures seront étudiés et comparés avec les données récentes de la littérature. L'anatomie hépatique peut être considérée de plusieurs façons morphologiquement (poids, faces, lobe droit, gauche et caudé...), fonctionnellement (segmentation en fonction de la distribution des pédicules portes et de la localisation des veines hépatiques) et chirurgicalement. La terminologie est rappelée (hépatectomies «typique », «atypique », «réglée », «majeure »...). A partir de ces données, les exérèses du foie sont ensuite classées. Les techniques d'hépatectomies sont expliquées, en rappelant les principes généraux, et les voies d'abord. Puis, les techniques de contrôle de l'hémostase, la reconstruction des voies biliaires, les méthodes utilisées par rapport à la tranche de section hépatique et à la loge d'hépatectomie sont discutées, Les acquisitions récentes sont abordées. Sur les 494 hépatecomies réalisées entre janvier 1992 et août 2001, 212 sont majeures. Elles sont reparties en 7 groupes selon l'exérèse (lobectomie G ou D, hépatecomie G ou D etc...). `Sur ces 212 résections, 177 cas concernaient des lésions malignes et 35 cas des lésions bénignes. Les indications ont été classées en 4 groupes : cancer primitif du foie, métastases hépatiques, maladies bénignes (par exemple l'échinococcose alvéolaire), et 8 cas classés dans le groupe «autres ». Une intervention en urgence a été réalisée dans 7 cas. Le bilan préopératoire comprend un bilan biologique et morphologique. Une embolisation de l'artère hépatique a été réalisées dans 6 cas, alors qu'une embolisation dans la veine porte a été faite dans 17 cas. Les modalités chirurgicales (voies d'abord, contrôle vasculaire, drainage biliaire post- opératoire, transfusions per- opératoires, et interventions extra- hépatiques) sont expliqués. En fin, les méthodes statistiques utilisées sont rappelées. Il n'y a pas eu de décès per- opératoire. La mortalité post- opératoire dans les 30 jours a été de 3,3 % (7 cas) et la mortalité globale hospitalière de 5,2 %. Dans cette série, 132 patients n'ont eu aucune complication. La morbidité est de 17% si on considère les complications majeures, ayant concerné 36 patients, mais de 37,75 si l'on considère toutes les complications. Les complications chirurgicales sont le faite d'hémorragie, de fuite biliaire et d'infection du foyer opératoire. Dans notre étude, 33 facteurs de risque ont été analysés. L'analyse statistique uni- variée met den évidence les facteurs de risque suivants : Le nombre de culots de sang transfusés, la présence d'une hépatite, celle d'une cirrhose, le tabagisme, la lobectomie droite, et la présence d'une hypertension artérielle. L'analyse multi variée réalisée a permis de faire ressortir une combinaison de facteur de risque avec une valeur statistique significative et de réaliser une échelle et un score de gravité en fonction des facteurs de risques obtenus dans l'analyse uni variée. Le taux de mortalité globale hospitalière obtenu dans notre série (5,2%) est comparable aux résultats reportés dans d'autres séries.