Organic law regulating euthanasia: knowledge and involvement of doctors in Spain one year after its implementation.

Background And Aims: The Organic Law Regulating Euthanasia (LORE, for its initials in Spanish) came into force in June 2021. This study aims to examine knowledge of the LORE among physicians licensed in Spain as well as their involvement with and the impact of the law.

Methods: This work is a descriptive, cross-sectional study conducted by means of a survey.

[Quality in medicine as a deontological requirement].

Medical practice has two main dimensions, one scientific and the other human, and in both, the commitment of the doctor is essential. Medical deontology, as a branch of ethics that deals with the duties and obligations of doctors, embodies in the codes of deontology the ethical principles and standards of mandatory compliance. From this point, medical practice should guarantee that patients receive an quality medical care, and to be treated with dignity and respect.

Leadership, management, quality, and innovation in organ donation: 2019 Kunming recommendations for One Belt & One Road countries.

The findings and recommendations of the 2019 consensus conference in organ donation, held in Kunming, China, are here reported. The main objective of the conference was to gather relevant information from experts involved in the field. The data and opinions provided allowed to propose a series of recommendations for "One Belt & One Road Countries" on how to achieve self-sufficiency in organ donation.

Intensive Care Unit Approach to the Diagnosis of Brain Death in Infratentorial Neurologic Pathology: Case Reports.

The ischemic and primary vascular injury of the brainstem (BS) can determine, among other serious conditions, the brain death (BD) of the individual. We present 2 cases of individuals with primary ischemic vascular disease of the BS who evolved to BD and were donors of solid organs and tissues. In both cases, the clinical examination was positive for the diagnosis of BD, and transcranial Doppler did not confirm the pattern of cerebral circulatory arrest that accompanies BD.

International consensus on the monitoring of cerebral oxygen tissue pressure in neurocritical patients.

Continuous monitoring of cerebral oxygenation and its application to the management of the severe neurological patient is a challenge for the management of patients with acute critical brain damage. Although several techniques have been described for monitoring brain, brain tissue oxygen monitoring provides relevant information about oxygen levels of brain tissue. However, the development of this technique has been associated with the need to answer not only some technical aspects of it as well as the meaning of the changes of the cerebral oxygenation in the neurocritical patient.

Practical document on the management of hyponatremia in critically ill patients.

Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions.

S100B protein may detect brain death development after severe traumatic brain injury.

Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI.

Effects of medetomidine and medetomidine-butorphanol on transcranial color-coded duplex ultrasonography in healthy dogs.

The study was designed to determine the effects of two protocols of sedation, medetomidine and medetomidine-butorphanol, on cerebral blood flow (CBF) by transcranial color-coded Duplex ultrasonography in healthy dogs. Transcranial Doppler ultrasonographic examination was performed in 20 dogs before and 20 min after sedation with either medetomidine (group 1) or medetomidine-butorphanol (group 2). The left and right middle cerebral arteries (LMCA and RMCA) were evaluated using the temporal windows, and the basilar artery (BA) was studied through the suboccipital window.

Efficacy and safety of caspofungin in critically ill patients. ProCAS Study.

Introduction: Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). ProCAS is a study sponsored by the Working Group of the Infectious Diseases of the Spanish Society of Intensive Care Medicine, which analyzes the effectiveness and safety of caspofungin in routine clinical practice conditions in the critically ill.

Methods: A prospective, multicenter, observational study designed to estimate the clinical effectiveness and safety of caspofungin acetate in the treatment of IC and IA in patients refractory to or intolerant of conventional antifungal therapy.

Role of S100B protein in urine and serum as an early predictor of mortality after severe traumatic brain injury in adults.

S100B is a calcium-binding protein released into the blood from astroglial cells due to brain injury. Some authors have described a correlation between S100B serum concentration and severity of brain damage. There is not much information about the accuracy of urinary S100B for predicting outcome after severe traumatic brain injury (TBI).

Clinical variables and neuromonitoring information (intracranial pressure and brain tissue oxygenation) as predictors of brain-death development after severe traumatic brain injury.

Background And Purpose: The aim of this study was to ascertain the role of clinical variables and neuromonitoring data as predictors of brain death (BD) after severe traumatic brain injury (TBI).

Patients And Methods: This prospective observational study involved severe TBI patients admitted to the intensive care unit between October 2009 and May 2011. The following variables were recorded: gender, age, reference Glasgow Coma Scale after resuscitation, pupillary reactivity, prehospital hypotension and desaturation, injury severity score, computed tomography (CT) findings, intracranial hypertension, and low brain tissue oxygenation (Pti02) levels (<16 mm Hg), as well as the final result of BD.

Role of early cell-free DNA levels decrease as a predictive marker of fatal outcome after severe traumatic brain injury.

Introduction: Circulating cell-free DNA levels are increased after trauma injury. This increase is higher since the first hours after trauma and may be related with primary outcome. A sensitive and reliable biomarker for patients at higher risk is needed to identify these patients to initiate early intervention.

Accuracy of the S100β protein as a marker of brain damage in traumatic brain injury.

Introduction: This study tested the hypothesis that S100β is a useful screening tool for detecting intracranial lesion (IL) in patients with a normal level of consciousness after traumatic brain injury (TBI).

Methods: One hundred and forty-three post-TBI patients without a decrease in consciousness (GCS = 15) and with at least one neurological symptom (e.g.

Imaging diagnosis-transcranial color-coded duplex sonography in a dog with hepatic encephalopathy.

We report the use of transcranial Doppler ultrasonography in a dog with hepatic encephalopathy secondary to a congenital portosystemic shunt. A severe increase in the pulsatility index was measured in the right middle cerebral artery, left middle cerebral artery, and basilar artery. These values returned to normal following medical stabilization of the patient and resolution of the neurologic signs.

Effect of transient carotid artery compression during transcranial Doppler ultrasonography in dogs.

Changes in blood flow in the arteries of the canine skull base following compression of the ipsilateral carotid artery were evaluated. Forty healthy conscious dogs were evaluated during examination in lateral recumbency. Using the temporal window, the rostral, middle and caudal cerebral arteries were evaluated.

Gender influences cerebral oxygenation after red blood cell transfusion in patients with severe traumatic brain injury.

Background: Important differences with respect to gender exist in the prognosis and mortality of traumatic brain injury (TBI) patients. The objective of this study was to assess the role of gender as an independent factor in cerebral oxygenation variations following red blood cell transfusion (RBCT).

Methods: This retrospective analysis of a prospective study was conducted on patients with severe TBI.

The Infrascanner, a handheld device for screening in situ for the presence of brain haematomas.

Purpose: Early identification and treatment of intracranial haematomas in patients sustaining traumatic brain injury is fundamental to successful treatment. This pilot study evaluates the Infrascanner as a handheld medical screening tool for detection, in situ, of brain haematomas in patients with head injury.

Methods: This study included 35 TBI patients aged 17-76 (M = 47.

[Brain death: repercussion on the organs and tissues].

Brain death is accompanied by a series of hemodynamic, hormonal and inflammatory systemic effects that have an important repercussion on the economy of the organs and tissues. There is increasing evidence that the organs from brain death donors have an inflammatory response grade secondary to brain death and sometimes proportional to the intensity and rate of its progression. Both clinical and experimental studies have shown that the result of organs from heart arrest deceased donors or live donors have the same or better clinical results than those obtained in brain death donors and who have suffered the inflammatory process secondary to it.

Assessing Circle of Willis blood circulation in dogs with transcranial color-coded duplex sonography.

Insonation of Circle of Willis by transcranial Doppler duplex color sonography is described in 30 healthy dogs with 15 weighing < 33 lb and 15 weighing >33 lb. Imaging was via a temporal window to explore the rostral, middle, and caudal cerebral arteries on both the left and right-hand sides; and through an suboccipital window to study the basilar artery. Normal mean values of the peak systolic velocity (PSV), end diastolic velocity, mean velocity, resistance index (RI), and pulsatility index (PI) were characterized and compared with those obtained in previous studies.

[Monitoring of tissue oxygen pressure (PtiO2) in cerebral hypoxia: diagnostic and therapeutic approach].

One of the main causes of secondary cerebral injury is cerebral hypoxia, basically of ischemic origin. However, cerebral tissue oxygenation depends on multiple physiological variables and cerebral hypoxia may be caused by an alteration of any one of them. Although several methods of continuous cerebral oxygenation monitoring of neurocritical patients have been developed, direct and continuous measurement of the oxygen pressure in the cerebral tissue (PtiO2) has been a reality in the handling of the neurocritical patients over recent years.

Empiric broad-spectrum antibiotic therapy of nosocomial pneumonia in the intensive care unit: a prospective observational study.

Introduction: Antibiotic de-escalation, which consists of the initial institution of empiric broad-spectrum antibiotics followed by antibiotic streamlining driven by microbiological documentation, is thought to provide maximum benefit for the individual patient, while reducing the selection pressure for resistance.

Methods: To assess a carbapenem-based de-escalating strategy in nosocomial pneumonia (NP), a prospective observational study was conducted in critically ill patients with NP treated empirically with imipenem +/- aminoglycoside/glycopeptide in 24 intensive care units of Spanish general hospitals. Overall, 244 patients were assessable (91% with late-onset NP).