Eduard Sanjurjo

Noninvasive Diagnosis of Mitochondrial Dysfunction in HAART-Related Hyperlactatemia

This study explores the role played by the welfare state in affecting women’s labor force participation and occupational achievement. Using data from 22 industrialized countries, the authors examine the consequences of state interventions for both women’s employment patterns and gender inequality in occupational attainment. The findings reveal a twofold effect: developed welfare states facilitate women’s access into the labor force but not into powerful and desirable positions. Specifically, nations characterized by progressive and developed welfare policies and by a large public service sector tend to have high levels of female labor force participation, along with a high concentration of women in female‐typed occupations and low female representation in managerial occupations. The findings provide insights into the social mechanisms underlying the relations between welfare states’ benefits to working mothers and women’s participation and achievements in the labor market.This study explores the role played by the welfare state in affecting women’s labor force participation and occupational achievement. Using data from 22 industrialized countries, the authors examine the consequences of state interventions for both women’s employment patterns and gender inequality in occupational attainment. The findings reveal a twofold effect: developed welfare states facilitate women’s access into the labor force but not into powerful and desirable positions. Specifically, nations characterized by progressive and developed welfare policies and by a large public service sector tend to have high levels of female labor force participation, along with a high concentration of women in female‐typed occupations and low female representation in managerial occupations. The findings provide insights into the social mechanisms underlying the relations between welfare states’ benefits to working mothers and women’s participation and achievements in the labor market.

Urgencias por cocaína: un problema emergente

Fundamento y objetivo En los ultimos anos ha aumentado en Espana el consumo de cocaina, por lo que podrian estar produciendose cada vez mas episodios de sobredosis. El uso asociado de otras drogas de abuso puede potenciar su toxicidad y, por tanto, incrementar las consultas a los servicios de urgencias (SU). Pacientes y metodo Se han recogido los datos de los pacientes que consultaron al SU y que referian consumo de cocaina en las horas previas. Se ha analizado la relacion entre la droga y el motivo de consulta y se han revisado las historias clinicas de una muestra para conocer su perfil clinico. Resultados Durante un periodo de 3 anos (2002-2004) se identifico a 745 pacientes (edad media de 31 anos, un 68% varones). La distribucion anual fue de 223 casos en el ano 2002, 232 en 2003 y 290 en 2004. El 53% de los pacientes consultaron durante el fin de semana y el 53% acudio al SU entre las 0 y las 12 h. Otras drogas asociadas al consumo de cocaina fueron el alcohol etilico (38%), los opiaceos (14%), el cannabis (13%) y los derivados anfetaminicos (9%). La cocaina fue el toxico causante del cuadro clinico en el 70% de los casos. Los motives principales de consulta fueron ansiedad o agitacion (48%) y dolor toracico o palpitaciones (25%). El 11% requirio ingreso hospitalario (19 casos en la unidad de cuidados intensivos) y se registraron 3 casos mortales. Conclusiones El consumo de cocaina, asociado casi siempre a otras drogas de abuso, ha generado un incremento de las consultas a los SU. Si bien la mortalidad es baja, el consumo de cocaine comporta morbilidad y frecuente ingreso hospitalario.

Análisis de las consultas generadas por el consumo de éxtasis en un servicio de urgencias

BACKGROUND AND OBJECTIVE: There has been in recent years an increase in the number of medical emergencies due to the consumption of designer drugs. We decided to study the characteristics of medical emergencies generated by the consumption of amphetamine derivates. PATIENTS AND METHOD: For the period 2000-2002, the medical records of patients attending the Emergency Department (ED) who claimed to have consumed ecstasy or other amphetamine derivates or whose toxicological tests were positive for amphetamines were reviewed. RESULTS: A total of 230 cases were identified, of whom 135 attended the ED due directly to ecstasy consumption. The average age was 23 years and 68% were men. Most patients were attended on weekend nights. The main reasons for attendance at the ED were anxiety, agitation or cognitive disturbances, reduced consciousness and fits or motor disturbances. Eighty per cent of patients admitted having consumed ecstasy and 65% of patients had consumed additional drugs. Three severe cases were recorded: two died in the ED and another was admitted to the ICU. CONCLUSIONS: Ecstasy consumption generates common attendance at the Emergency Department and can be potentially fatal.

Prueba de ejercicio con isquemia en el antebrazo. Estandarización y valor diagnóstico en la identificación de la enfermedad de McArdle

Fundamento y objetivo: La prueba de ejercicio bajo isquemia en el antebrazo con determinaciones seriadas de lactato serico es la prueba mas utilizada para la deteccion y el diagnostico de la glucogenosis de McArdle; no obstante, la tecnica usada no es claramente uniforme en los diferentes textos de referencia. El objetivo del trabajo consiste en estandarizar las condiciones optimas de realizacion de la prueba y estudiar su validez en nuestra poblacion. Pacientes y metodo: El estudio se ha dividido en 2 etapas. Inicialmente se ha estudiado a 9 individuos sanos a los que se les ha sometido en 4 ocasiones a la tecnica modificando el grado y el tiempo de isquemia para valorar las condiciones que permiten obtener un mejor resultado. Una vez definidas estas condiciones, se ha aplicado la prueba a 3 grupos de pacientes: 5 pacientes previamente diagnosticados de McArdle, 30 individuos sanos y 25 pacientes afectados de diferentes tipos de miopatias no glucogenosicas. Resultados: Las condiciones en las que se ha obtenido un mejor perfil de resultados de las curvas han sido: inflar el esfigmomanometro 20 mmHg por encima de la presion arterial sistolica del paciente y realizar el ejercicio hasta la fatiga. Se ha demostrado la validez de la tecnica para el diagnostico de la glucogenosis tipo V (sensibilidad del 100% y especificidad del 96%) marcando como punto de corte entre normalidad y enfermedad la elevacion por encima de un 200% el valor basal de las curvas de lactato y amonio. En el grupo de las miopatias no glucogenosicas las curvas fueron claramente diferentes de las de la enfermedad de McArdle. No se produjo ninguna complicacion de importancia. Conclusiones: Han quedado establecidas las condiciones optimas de realizacion de la prueba de ejercicio con isquemia en el antebrazo en nuestra poblacion. Dadas las altas sensibilidad y especificidad, valoramos esta tecnica como de gran utilidad para el cribado y diagnostico de miopatias por afeccion del metabolismo anaerobio.

Eficacia y seguridad de la descontaminación digestiva en la intoxicación medicamentosa aguda

BACKGROUND AND OBJECTIVE: Gut decontamination (GD) may be used as a treatment for acute therapeutic drug overdose (ATDO) to reduce the absorption of the drug and thereby avoid the presence or worsening of signs and symptoms of intoxication. The objective of this study was to assess the efficacy and safety of GD in ATDO patients. PATIENTS AND METHOD: A 4-month prospective observational study was designed to include all patients admitted to the emergency department due to an ATDO. On admission, epidemiological data, vital signs and physical examination results were all recorded and a blood sample was taken for toxicological analysis. An algorithm was used to determine the GD method to be applied. A clinical reassessment was made at 3-6 hours and a further sample was taken for toxicological analysis. Patients were followed until hospital discharge, with all possible adverse events due to GD being recorded. RESULTS: Ninety-four patients were included. GD was indicated in 60 patients (63.8%): 3.3% received ipecacuana syrup, 8.3% gastric lavage, 21.6% gastric lavage followed by activated charcoal and 71.6% oral activated charcoal alone. The clinical state worsened in 19.1% of patients, usually on the basis of a diminished consciousness. Adverse events attributable to GD were observed in 8.3% of patients. A toxicological analysis was made in 50 patients and in 42% of them, drug concentrations were higher at 3 or 6 hours than on admission. An analysis of the method of decontamination used showed that the procedure recommended by the algorithm was applied in 70 patients (group A) while in the remaining 24 (group B) another decontamination technique was used. Clinical deterioration was seen in 14.3% of patients in group A and 33.3% in group B (p = 0.041). There was a favourable evolution of the analytic curve in 63.9% patients in group A and 42.9% in group B (p = NS); severe adverse events attributable to GD were suffered by 2.4% patients in group A and 11.1% in group B (p = NS). CONCLUSIONS: The efficacy and safety of GD in ATDO increases in patients in whom the decision-making algorithm is applied. However, this does not prevent clinical deterioration or continued drug absorption in all cases and may be accompanied by adverse events.