The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale mod... more The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score. We conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series. In-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score). Our new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation.
Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2... more Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2, 4-triazin-5-one) and imidacloprid (1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine) has been investigated by differential-pulse ...
Trace amounts of heavy metals have been analysed by electrochemical techniques in ecstasy tablets... more Trace amounts of heavy metals have been analysed by electrochemical techniques in ecstasy tablets obtained from different police seizures in Spain. Lead, cadmium, copper and zinc were determined by differential-pulse anodic stripping voltammetry at a hanging mercury drop electrode, whereas nickel and cobalt were determined by adsorptive differential-pulse cathodic stripping voltammetry from their dimethylglyoxime complexes, M(DMG)2. The performance of the procedure was compared with electrothermal atomic absorption spectrometry. The procedure was applied to the determination of these elements in nine ecstasy samples, finding that Zn is the element present in the highest concentration, ranging from 0.3 to 200 mg kg−1, Ni, Cu appear below 15 mg kg−1 and Pb below 8 mg kg−1, while Cd and Co levels were always lower than 0.51 mg kg−1.
Mercury and arsenic concentrations were determined in ecstasy tablets, which were obtained from d... more Mercury and arsenic concentrations were determined in ecstasy tablets, which were obtained from different police seizures in Spain, by electrochemical techniques; mercury by differential pulse anodic stripping voltammetry with a rotating gold disk electrode, and arsenic by cathodic stripping voltammetry in the differential pulse mode with a hanging mercury drop electrode. The performance of the procedures was compared with cold-vapor atomic absorption spectrometry for mercury, and with electrothermal atomic absorption spectrometry for arsenic. The procedures were applied to the determination of both elements in nine ecstasy samples; mercury was the element present in higher concentrations, ranging from 0.05 to 1.23 mg/kg, while the range of arsenic concentrations was 0.04–0.49 mg/kg. The described electrochemical techniques for determination of mercury and arsenic in ecstasy tablets should be useful for impurity profiling in forensic analysis practice, because of their low costs and high sensitivity.
Background: Alcohol consumption is associated with high rates of mortality. This study aimed to a... more Background: Alcohol consumption is associated with high rates of mortality. This study aimed to analyse mortality attributable to alcohol consumption in foreign-born and native-born Spaniards in 2004 and to determine whether differences existed between these groups. Methods: The number of deaths attributable to alcohol consumption was calculated by means of the alcohol-attributable fractions devised by the Center for Disease Control and Prevention for calculating mortality rates in the USA. Alcohol-related mortality rates and age-adjusted mortality rates per 100,000 persons (using European standard population) were calculated by gender.
Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2... more Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2, 4-triazin-5-one) and imidacloprid (1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine) has been investigated by differential-pulse ...
To assess fitness to drive among drivers with treated obstructive sleep apnea syndrome. A total o... more To assess fitness to drive among drivers with treated obstructive sleep apnea syndrome. A total of 5234 drivers who attended two Spanish Medical Driver Test Centers for assessment of their fitness to drive prior to renewing or issuing their driving license were included in the study. Information regarding sociodemographic aspects, patterns of driving, medical condition, medication use, and patterns of alcohol consumption was recorded. Eleven out of 5234 drivers (0.2%) suffered from obstructive sleep apnea syndrome, all of them being treated with continuous positive airway pressure, and they were found fit to drive with restrictions. A lower than expected prevalence of patients with obstructive sleep apnea syndrome was found among drivers undergoing fitness to drive assessment. Suffering from obstructive sleep apnea syndrome does not prevent driving as long as the patient is undergoing adequately controlled treatment.
Ventilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery pati... more Ventilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery patients and is associated with an important increase in morbidity and mortality. The aim of our study was to analyze the impact of VAP on mortality excluding other comorbidities and to study its etiology and the risk factors for its development. This prospective cohort study included 1610 postoperative cardiac surgery patients' status post cardiopulmonary bypass (CPB) between July 2004 and January 2008. The primary outcome measures were the development of VAP and in-hospital mortality. Ventilator-associated pneumonia was observed in 124 patients (7.7%). Patients with VAP had a longer length of hospitalization (40.7 ± 35.1 vs 16.1 ± 30.1 days, P < .0001) and greater in-hospital mortality (49.2% [61/124] vs 2.0% [30/1486], P = .0001) in comparison with patients without VAP. After performing the Cox multivariant analysis adjustment, VAP was identified as the most important independent mortality risk factor (adjusted hazard ratio [HR], 8.53; 95% confidence interval, 4.21-17.30; P = .0001). Other independent risk factors of in-hospital mortality were chronic renal failure (HR, 2.56), diabetes mellitus (HR, 1.90), CPB time (HR, 1.51), respiratory failure (HR, 2.13), acute renal failure (HR, 2.39), and mediastinal bleeding of at least 1000 mL (HR, 1.81). The development of VAP after CPB is the most important independent risk factor for in-hospital mortality. Identification of effective strategies for the prevention of VAP is needed.
Purpose: The aims were to analyze the temporal evolution of neutrophil apoptosis, to determine th... more Purpose: The aims were to analyze the temporal evolution of neutrophil apoptosis, to determine the differences in neutrophil apoptosis among 28-day survivors and nonsurvivors, and to evaluate the use of neutrophil apoptosis as a predictor of mortality in patients with septic shock. Materials and Methods: Prospective multicenter observational study carried out between July 2006 and June 2009. The staining solution study included 80 patients with septic shock and 25 healthy volunteers. Neutrophil apoptosis was assessed by fluorescein isothiocyanate (FITC)-conjugated annexin V and aminoactinomycin D staining. Results: The percentage of neutrophil apoptosis was significantly decreased at 24 hours, 5 days, and 12 days after the diagnosis of septic shock (14.8% ± 13.4%, 13.4% ± 8.4%, and 15.4% ± 12.8%, respectively; P b .0001) compared with the control group (37.6% ± 12.8%). The difference in apoptosis between 28-day surviving and nonsurviving patients was nonsignificant (P N .05). The mortality rate at 28 days was 53.7%.
Background: The perioperative use of high inspired oxygen fraction (FIO 2 ) for preventing surgic... more Background: The perioperative use of high inspired oxygen fraction (FIO 2 ) for preventing surgical site infections (SSIs) has demonstrated a reduction in their incidence in some types of surgery however there exist some discrepancies in this respect. The aim of this study was to analyze the relationship between PaO 2 values and SSIs in cardiac patients. Methods: We designed a prospective study in which 1,024 patients undergoing cardiac surgery were analyzed.
The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale mod... more The risk of mortality in cardiac surgery is generally evaluated using preoperative risk-scale models. However, intraoperative factors may change the risk factors of patients, and the organism functionality parameters determined upon ICU admittance could therefore be more relevant in deciding operative mortality. The goals of this study were to find associations between the general parameters of organism functionality upon ICU admission and the operative mortality following cardiac operations, to develop a Post Cardiac Surgery (POCAS) Scale to define operative risk categories and to validate an operative mortality risk score. We conducted a prospective study, including 920 patients who had undergone cardiac surgery with cardiopulmonary bypass. Several parameters recorded on their ICU admission were explored, looking for a univariate and multivariate association with in-hospital mortality (90 days). In-hospital mortality was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate, lactate and the International Normalized Ratio (INR). The POCAS scale was compared with four other risk scores in the validation series. In-hospital mortality (90 days) was 9%. Four independent factors were included in the POCAS mortality risk model: mean arterial pressure, bicarbonate ratio, lactate ratio and the INR. The POCAS scale was compared with four other risk scores in the validation series. Discriminatory power (accuracy) was defined with a receiver-operating characteristics (ROC) analysis. The best accuracy in predicting in-hospital mortality (90 days) was achieved by POCAS. The areas under the ROC curves of the different systems analyzed were 0.890 (POCAS), followed by 0.847 (Simplified Acute Physiology Score (SAP II)), 0.825 (Sepsis-related Organ Failure Assessment (SOFA)), 0.768 (Acute Physiology and Chronic Health Evaluation (APACHE II)), 0.754 (logistic EuroSCORE), 0.714 (standard EuroSCORE) and 0.699 (Age, Creatinine, Ejection Fraction (ACEF) score). Our new system to predict the operative mortality risk of patients undergoing cardiac surgery is better than others used for this purpose (SAP II, SOFA, APACHE II, logistic EuroSCORE, standard EuroSCORE, and ACEF score). Moreover, it is an easy-to-use tool since it only requires four risk factors for its calculation.
Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2... more Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2, 4-triazin-5-one) and imidacloprid (1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine) has been investigated by differential-pulse ...
Trace amounts of heavy metals have been analysed by electrochemical techniques in ecstasy tablets... more Trace amounts of heavy metals have been analysed by electrochemical techniques in ecstasy tablets obtained from different police seizures in Spain. Lead, cadmium, copper and zinc were determined by differential-pulse anodic stripping voltammetry at a hanging mercury drop electrode, whereas nickel and cobalt were determined by adsorptive differential-pulse cathodic stripping voltammetry from their dimethylglyoxime complexes, M(DMG)2. The performance of the procedure was compared with electrothermal atomic absorption spectrometry. The procedure was applied to the determination of these elements in nine ecstasy samples, finding that Zn is the element present in the highest concentration, ranging from 0.3 to 200 mg kg−1, Ni, Cu appear below 15 mg kg−1 and Pb below 8 mg kg−1, while Cd and Co levels were always lower than 0.51 mg kg−1.
Mercury and arsenic concentrations were determined in ecstasy tablets, which were obtained from d... more Mercury and arsenic concentrations were determined in ecstasy tablets, which were obtained from different police seizures in Spain, by electrochemical techniques; mercury by differential pulse anodic stripping voltammetry with a rotating gold disk electrode, and arsenic by cathodic stripping voltammetry in the differential pulse mode with a hanging mercury drop electrode. The performance of the procedures was compared with cold-vapor atomic absorption spectrometry for mercury, and with electrothermal atomic absorption spectrometry for arsenic. The procedures were applied to the determination of both elements in nine ecstasy samples; mercury was the element present in higher concentrations, ranging from 0.05 to 1.23 mg/kg, while the range of arsenic concentrations was 0.04–0.49 mg/kg. The described electrochemical techniques for determination of mercury and arsenic in ecstasy tablets should be useful for impurity profiling in forensic analysis practice, because of their low costs and high sensitivity.
Background: Alcohol consumption is associated with high rates of mortality. This study aimed to a... more Background: Alcohol consumption is associated with high rates of mortality. This study aimed to analyse mortality attributable to alcohol consumption in foreign-born and native-born Spaniards in 2004 and to determine whether differences existed between these groups. Methods: The number of deaths attributable to alcohol consumption was calculated by means of the alcohol-attributable fractions devised by the Center for Disease Control and Prevention for calculating mortality rates in the USA. Alcohol-related mortality rates and age-adjusted mortality rates per 100,000 persons (using European standard population) were calculated by gender.
Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2... more Abstract The photochemical degradation of metamitron (4-amino-4, 5-dihydro-3-methyl-6-phenyl-1, 2, 4-triazin-5-one) and imidacloprid (1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine) has been investigated by differential-pulse ...
To assess fitness to drive among drivers with treated obstructive sleep apnea syndrome. A total o... more To assess fitness to drive among drivers with treated obstructive sleep apnea syndrome. A total of 5234 drivers who attended two Spanish Medical Driver Test Centers for assessment of their fitness to drive prior to renewing or issuing their driving license were included in the study. Information regarding sociodemographic aspects, patterns of driving, medical condition, medication use, and patterns of alcohol consumption was recorded. Eleven out of 5234 drivers (0.2%) suffered from obstructive sleep apnea syndrome, all of them being treated with continuous positive airway pressure, and they were found fit to drive with restrictions. A lower than expected prevalence of patients with obstructive sleep apnea syndrome was found among drivers undergoing fitness to drive assessment. Suffering from obstructive sleep apnea syndrome does not prevent driving as long as the patient is undergoing adequately controlled treatment.
Ventilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery pati... more Ventilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery patients and is associated with an important increase in morbidity and mortality. The aim of our study was to analyze the impact of VAP on mortality excluding other comorbidities and to study its etiology and the risk factors for its development. This prospective cohort study included 1610 postoperative cardiac surgery patients' status post cardiopulmonary bypass (CPB) between July 2004 and January 2008. The primary outcome measures were the development of VAP and in-hospital mortality. Ventilator-associated pneumonia was observed in 124 patients (7.7%). Patients with VAP had a longer length of hospitalization (40.7 ± 35.1 vs 16.1 ± 30.1 days, P < .0001) and greater in-hospital mortality (49.2% [61/124] vs 2.0% [30/1486], P = .0001) in comparison with patients without VAP. After performing the Cox multivariant analysis adjustment, VAP was identified as the most important independent mortality risk factor (adjusted hazard ratio [HR], 8.53; 95% confidence interval, 4.21-17.30; P = .0001). Other independent risk factors of in-hospital mortality were chronic renal failure (HR, 2.56), diabetes mellitus (HR, 1.90), CPB time (HR, 1.51), respiratory failure (HR, 2.13), acute renal failure (HR, 2.39), and mediastinal bleeding of at least 1000 mL (HR, 1.81). The development of VAP after CPB is the most important independent risk factor for in-hospital mortality. Identification of effective strategies for the prevention of VAP is needed.
Purpose: The aims were to analyze the temporal evolution of neutrophil apoptosis, to determine th... more Purpose: The aims were to analyze the temporal evolution of neutrophil apoptosis, to determine the differences in neutrophil apoptosis among 28-day survivors and nonsurvivors, and to evaluate the use of neutrophil apoptosis as a predictor of mortality in patients with septic shock. Materials and Methods: Prospective multicenter observational study carried out between July 2006 and June 2009. The staining solution study included 80 patients with septic shock and 25 healthy volunteers. Neutrophil apoptosis was assessed by fluorescein isothiocyanate (FITC)-conjugated annexin V and aminoactinomycin D staining. Results: The percentage of neutrophil apoptosis was significantly decreased at 24 hours, 5 days, and 12 days after the diagnosis of septic shock (14.8% ± 13.4%, 13.4% ± 8.4%, and 15.4% ± 12.8%, respectively; P b .0001) compared with the control group (37.6% ± 12.8%). The difference in apoptosis between 28-day surviving and nonsurviving patients was nonsignificant (P N .05). The mortality rate at 28 days was 53.7%.
Background: The perioperative use of high inspired oxygen fraction (FIO 2 ) for preventing surgic... more Background: The perioperative use of high inspired oxygen fraction (FIO 2 ) for preventing surgical site infections (SSIs) has demonstrated a reduction in their incidence in some types of surgery however there exist some discrepancies in this respect. The aim of this study was to analyze the relationship between PaO 2 values and SSIs in cardiac patients. Methods: We designed a prospective study in which 1,024 patients undergoing cardiac surgery were analyzed.
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