José L. Merino

Tratamiento antimicrobiano de la agudización de la EPOC: Documento de Consenso 2007

En el año 2002 miembros de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Quimioterapia (SEQ), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), la Sociedad Española de Medicina General (SEMG) y la Sociedad Española de Medicina Rural y Generalista (SEMERGEN) elaboraron el Segundo Documento de Consenso sobre el uso de antimicrobianos en la agudización de la enfermedad pulmonar obstructiva crónica (EPOC)1. Cinco años después, expertos de las mismas sociedades, conscientes de la amplia difusión e interés práctico que en su momento tuvo el citado documento, se han reunido de nuevo con objeto de actualizarlo a la luz de la bibliografía médica más relevante publicada durante este período. Este Documento de Consenso 2007 incorpora nuevos conocimientos sobre la valoración que ha de darse a la purulencia del esputo en la indicación del tratamiento antibiótico y la evolución de la tasa de resistencia de los principales patógenos frente a los antimicrobianos recomendados en su momento, y recoge la experiencia obtenida en el transcurso de estos años con el empleo de las fluoroquinolonas, la nueva formulación de amoxicilina-ácido clavulánico de liberación retardada, que posibilita la administración oral de dosis elevadas de amoxicilina, y las cefalosporinas orales de tercera generación como el cefditorén, que muestran una elevada actividad intrínseca frente a cepas de neumococo resistente a penicilina.

Nuevas evidencias, nuevas controversias: análisis crítico de la guía de práctica clínica sobre fibrilación auricular 2010 de la Sociedad Europea de Cardiología

Manuel Anguita,* Fernando Worner, Pere Domenech, Francisco Marı́n, Javier Ortigosa, Julián Pérez-Villacastı́n, Antonio Fernández-Ortiz, Angel Alonso, Angel Cequier, Josep Comı́n, Magda Heras, Manuel Pan, Javier Alzueta, Angel Arenal, Gonzalo Barón, Xavier Borrás, Ramón Bover, Mariano de la Figuera, Carlos Escobar, Miguel Fiol, Benito Herreros, José L. Merino, Lluis Mont, Nekane Murga, Alonso Pedrote, Aurelio Quesada, Tomás Ripoll, José Rodrı́guez, Martı́n Ruiz, and Ricardo Ruiz Coordinadores del Grupo de Trabajo sobre Guı́as de Fibrilación Auricular de la Sociedad Española de Cardiologı́a, Madrid, Spain Grupo de Trabajo sobre Guı́as de Fibrilación Auricular de la Sociedad Española de Cardiologı́a, Madrid, Spain Comité de Guı́as de Práctica Clı́nica de la Sociedad Española de Cardiologı́a, Madrid, Spain Grupo de expertos revisores del documento sobre Guı́as de Fibrilación Auricular de la Sociedad Española de Cardiologı́a, Madrid, Spain

A reusable smart interface for gas sensor resistance measurement

The advances of the semiconductor industry enable microelectromechanical systems sensors, signal conditioning logic and network access to be integrated into a smart sensor node. In this framework, a mixed-mode interface circuit for monolithically integrated gas sensor arrays was developed with high-level design techniques. This interface system includes analog electronics for inspection of up to four sensor arrays and digital logic for smart control and data communication. Although different design methodologies were used in the conception of the complete circuit, high-level synthesis tools and methodologies were crucial in speeding up the whole design cycle, enhancing reusability for future applications and producing a flexible and robust component.

Antimicrobial Treatment of Exacerbation in Chronic Obstructive Pulmonary Disease: 2007 Consensus Statement *

In 2002, members of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of General Medicine (SEMG), and the Spanish Society of Rural and General Medicine (SEMERGEN) prepared the second consensus report on the use of antimicrobial agents in exacerbations of chronic obstructive pulmonary disease (COPD).1 Given the widespread practical interest in that consensus statement, experts from the same societies met 5 years later to prepare an updated statement in the light of literature published in the intervening period. This 2007 Consensus Statement will include new information regarding the significance of purulent sputum in the decision to prescribe antibiotic treatment and changes in the rate of resistance of the main pathogens to previously recommended antimicrobial drugs. It reports on the experience obtained in the last 5 years with the use of fluoroquinolones, the new slow-release formulation of amoxicillin-clavulanic acid, which allows oral administration of high-dose amoxicillin, and the third-generation oral cephalosporins, such as cefditoren, which have a high intrinsic activity against penicillin-resistant strains of pneumococcus.

Guía Clínica Española del Acceso Vascular para Hemodiálisis

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.

Aplicación de una pauta de hemodiálisis incremental, basada en la función renal residual, al inicio del tratamiento renal sustitutivo

Introduction nThe interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008.INTRODUCTIONnThe interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008.nnnMATERIAL AND METHODSnWe included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: Clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities.nnnRESULTSnA total of 24patients were included in incremental technique. The mean age at start of RRT was 60 (15 years. The average time on incremental technique was 19 (18 months (range: 7-80), with a mean time on dialysis of 31 (23 months (range: 12-86). The reasons for transfer to thrice-weekly HD were: in 6patients due to laboratory tests, in 2patients for heart failure events, one for poor compliance and 3for receiving a kidney graft. The residual diuresis decreased in the first year from 2,106 (606ml/day to 1,545 (558 (P=.17) with the urea clearance and calculated residual renal function, basal 5.7 (1.5vs. 3.8 (1.9ml/min per year (P=.01) and basal 8.9 (2.4vs. 6.9 (4.3 per year (P=.28), respectively.nnnCONCLUSIONSnIncremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.

Soft error rate comparison of 6T and 8T SRAM ICs using mono-energetic proton and neutron irradiation sources

Abstract We present experimental results of soft errors produced by proton and neutron irradiation of minimum-size six-transistors (6T) and eight-transistors (8T) bit-cells SRAM memories produced with 65xa0nm CMOS technology using an 18xa0MeV proton beam and a neutron beam of 4.3–8.5xa0MeV. All experiments have been carried out at the National Center of Accelerators (CNA) in Seville, Spain. Similar soft error rate levels have been observed for both cell designs despite the larger area occupied by the 8T cells, although the trend for multiple events has been higher in 6T.

Respuesta al artículo: «Brote de bacteriemia por Serratia marcescens en hemodiálisis». Comentarios al artículo: «Brote de bacteriemia por Serratia marcescens en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros»

microangiopathy and persistent acute kidney injury (AKI). Clin Kidney J. 2014;7:1–4. 4. Hickson RC, Ball KL, Falduto MT. Adverse effects of anabolic steroids. Med Toxicol Adverse Drug Exp. 1989;4:254–71. 5. Casavant MJ, Kathleen B, Griffith J. Consequences of use of anabolic androgenics sterodis. Pediatric Clin. 2007;54:677–90. 6. Varon J, Marik PE. The diagnosis and management of hypertensive crises. Chest. 2000;118:214–27. 7. Montgomery HE, Kiernan LA, Whitworth CE. Inhibition of tissue angiotensin converting enzyme activity prevents malignan hypertension in TGR(mREN2)27. J Hypertens. 1998;16:635–43.

Fe de errores de «Guía Clínica Española del Acceso Vascular para Hemodiálisis»

José Ibeasa,∗, Ramon Roca-Teyb, Joaquín Vallespín c, Teresa Morenod, Guillermo Moñux e, Anna Martí-Monrós f, José Luis del Pozog, Enrique Grussh, Manel Ramírez de Arellano i, Néstor Fontseré j, María Dolores Arenask, José Luis Merino l, José García-Revillom, Pilar Caron, Cristina López-Espada , Antonio Giménez-Gaibar c, Milagros Fernández-Lucas o, Pablo Valdésp, Fidel Fernández-Quesada , Natalia de la Fuenteq, David Hernán r, Patricia Arribas s, María Dolores Sánchez de la Nieta t, María Teresa Martínezu, Ángel Barbaq y por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV)

Dialysis arteriovenous access monitoring and surveillance according to the 2017 Spanish Guidelines

The Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology (S.E.N.), vascular surgery (SEACV), interventional radiology (SERAM-SERVEI), infectious diseases (SEIMC), and nephrology nursing (SEDEN)), along with the methodological support of the Iberoamerican Cochrane Centre, has developed the Spanish Clinical Guidelines on Vascular Access for Hemodialysis. This article summarizes the main issues from the guideline’s chapter entitled “Monitoring and surveillance of arteriovenous access.” We will analyze the current evidence on conflicting topics such as the value of the flow-based screening methods for the arteriovenous access surveillance or the role of Doppler ultrasound as the imaging exploration to confirm suspected stenosis. In addition, the concept of significant stenosis and the criteria to perform the elective intervention for stenosis were reviewed. The adoption of these guidelines will hopefully translate into a reduced risk of thrombosis and increased patency rates for both arteriovenous fistulas and grafts.