Capacidades sanitarias del buque de proyección estratégica L-61 Juan Carlos I. Lecciones médicas identificadas tras las maniobras FLOTEX-17 / Health capacity of the strategic projection warship Juan Carlos I. Medical lessons identified after the FLOTEX-17 maneouvers

El Buque de Proyección Estratégica L-61 Juan Carlos I (L-61 JC I) es el buque de mayores dimensiones que ha tenido la Armada española en toda su historia. Puede desarrollar cuatro perfiles de misión: anfibio, portaviones, transporte estratégico y ayuda humanitaria. En todos ellos su capacidad sanitaria Role 2 juega un papel determinante gracias a las importantes prestaciones médicas con las que cuenta el buque. Las maniobras FLOTEX-17 realizadas en el Mar Mediterráneo en junio de 2017 en las que participaron 29 buques y más de 3500 efectivos fue la primera vez que embarcó un Role 2 en el L-61 JC I. El objetivo de este artículo es describir las características técnicas y sanitarias del buque, las lecciones identificadas obtenidas tras las maniobras navales y analizar las semejanzas y diferencias de buques similares de marinas de guerra aliadas

Strategic Projection Ship L-61 Juan Carlos I (L-61 JC I) is the largest ship that the Spanish Navy has had in its history. This warship can develop four mission profiles: amphibian, aircraft carrier, strategic transport and humanitarian aid. In all of them, Role 2 medical capacity and capability plays a decisive role thanks to the important medical benefits available in the ship. FLOTEX-17 maneuvers carried out in the Mediterranean Sea in June 2017 with the participation of 29 warships and more than 3,500 navy members was the first time that a Role 2 was shipped in the L-61 JC I. The purpose of this article is to describe warship technical and medical characteristics, lessons identified after the naval maneuvers and analyze the similarities and differences of similar warships of allied navies

Cuerpo extraño intraabdominal / Intraabdominal foreign body

No disponible

Assessing Effects and interactions among key variables affecting the growth of mixotrophic microalgae: pH, inoculum volume, and growth medium composition.

A 2(3) + 3 full factorial experimental design was used to evaluate growth rate and biomass productivity of four selected, high-biomass-yielding microalgae species,namely, Chlorella vulgaris (CV), Scenedesmus acutus (SA), Chlamydomonas reinhardtii (CR), and Chlamydomonas debaryana (CD), in mixtures of growth medium (MWC) and wastewater at different proportions (from 20 to 50% of MWC) and at different pH (from 7 to 9). Multilinear regression analysis of the biomass productivity data showed that for SA and CD the biomass productivity was independent of the proportion of medium (MWC), while the growth of CV and CR slowed down in mixtures with high proportions of wastewater. However, the biomass productivity of SA was dependent on pH, while the growth of the other microalgae was independent of pH (7-9). When evaluating the influence of pH and proportion of medium, CD appeared most robust among the algae species, despite its lower biomass productivity. All the four species reduced 80-90% of the nitrate [Formula: see text] and 60-70% of the ammonia [Formula: see text] initially present in the wastewater:medium mixture, although the extent of the reduction was dependent on the initial [Formula: see text] ratio. Both SA and CV reduced ∼20-25% of the chemical oxygen demand (COD) contained in the wastewater. This study shows the remarkable influence of certain variables that are often ignored in the search for optimal conditions of microalgal growth and also reveals the importance of considering interactions among growth variables in potential applications at large scale, particularly in the field of bioremediation.

Admixture estimates for the population of Havana City.

BACKGROUND: The Cuban population is essentially a result of the admixture between Spanish, West African and, to a lesser degree, Amerindian tribes that inhabited the island. AIM: The study analysed the genetic structure of the three principal ethnic groups from Havana City, and the contribution of parental populations to its genetic pool. SUBJECTS AND METHODS: According to genealogical information and anthropological traits, 206 subjects were classified as Mulatto, of Spanish decent or of African descent. Seventeen Ancestry Informative Markers, with high difference in frequency between parental populations, were selected to estimate individual and group admixture proportions. The statistical analyses were performed using the ADMIX, ADMIX95 and STRUCTURE 2.1 packages. RESULTS: The results demonstrate a high level of European and African admixture in Mulattos (57-59% European; 41-43% West African). The European contribution was higher in those of Spanish descent (85%) while in those of African descent, the West African contribution ranged between 74% and 76%. Genetic structure was only detected in Mulattos and those of African descent. An Amerindian contribution was not detectable in the studied sample. CONCLUSION: Our findings indicate the existence of admixture and genetic structure in the population of Havana City. This study represents one of the first steps towards understanding Cuban population admixture in order to produce successful experimental designs for admixture mapping.

[Assessment of hypothalamo-pituitary axis in early phase of severe cranioencephalic brain injury]. / Valoración del eje hipotálamo-hipofisario en la fase precoz del traumatismo craneoencefálico grave.

OBJECTIVE: To assess early pituitary function in a sequential cohort of critical care patients after severe traumatic brain injury (TBI). DESIGN: This was a prospective observational study. The pituitary function was always tested on the third day after TBI. SETTING: Neurocritical intensive care unit (ICU) in a University hospital. PATIENTS: A total of 136 adult patients with severe TBI (range, 16-65 years) enrolled over a 2 year and 9 month period having a stay in the ICU treated than 48 hours. INTERVENTION: None. MEASUREMENTS AND DATA COLLECTED: The following data were recorded within the first 72 hours after injury: demographic variables, injury severity, neuromonitoring data, systemic secondary brain insults, use of vasoactive drugs and type of TBI according to the computerized tomography (CT) scan findings. Pituitary function was evaluated by measurement of both the pituitary and target organ hormones, with the exception of the somatotrophic function, which was assessed by measurement of basal serum values of insulin-like growth factor-I (IGF-I). RESULTS: Pituitary dysfunction was observed in 101 patients (74.2%). Seventy-nine patients (58%) had impairment of only one pituitary axis, the axes being affected as follows: gonadotropic 63.7% (87 patients), thyrotropic 8.8% (12 patients) and corticotropic 0.7% (1 patient). Low IGF-1 plasmatic levels in accordance to the patient's age were observed in 90 patients (66.7%). However, only 26 of them had a value below 90 ng/ml. CONCLUSIONS: Our data show that pituitary dysfunction occurs early and with high frequency after severe TBI, but the real significance of these findings still needs to be elucidated.

Valoración del eje hipotálamo-hipofisario en la fase precoz del traumatismo craneoencefálico grave / Assessment of hypothalamo-pituitary axis in early phase of severe cranioencephalic brain injury

Objetivo. Analizar las características de la función hipofisaria en la fase inicial de pacientes críticos con traumatismo craneoencefálico grave (TCEG). Diseño. Estudio observacional, prospectivo. La función hipofisaria se evaluó siempre el tercer día tras el TCEG. Ámbito. Unidad de cuidados intensivos (UCI) neurotraumatológica de un hospital universitario. Pacientes. Se incluyó a 136 pacientes con TCEG (intervalo, 16-65 años), durante un período de 2 años y 9 meses y estancia en UCI mayor de 48 h. Intervención. Ninguna. Medidas y datos recopilados. Se recogieron durante las primeras 72 h tras el traumatismo: variables demográficas, severidad de la lesión, parámetros de neuromonitorización, lesiones cerebrales secundarias, uso de fármacos vasoactivos y el tipo de traumatismo craneoencefálico (TCE) acorde a los hallazgos encontrados en la tomografía computarizada (TC). La evaluación de la función hipofisaria se determinó por medición de hormonas hipofisarias y las de los órganos diana, con la excepción de la función somatotropa, que se evaluó midiendo las concentraciones séri- cas basales de insulin-like growth factor-1 (IGF-1). Resultados. Se observó disfunción hipofisaria en 101 (74,2%) pacientes; 79 (58%) pacientes tenían afectado solamente un eje hipofisario, la afectación de ejes es la siguiente: gonadotropo, el 63,7% (87 pacientes); tirotropo, el 8,8% (12 pacientes), y corticotropo, el 0,7% (1 paciente). Se observaron concentraciones plasmáticas bajas de IGF-1 acorde a la edad en 90 (66,7%) pacientes, aunque sólo 26 de ellos mostraron un valor menor de 90 ng/ml. Conclusiones. Nuestros datos muestran que la disfunción hipofisaria ocurre precozmente y con gran frecuencia tras un TCEG, aunque el significado real de estos hallazgos están aún por determinar

Objective. To assess early pituitary function in asequential cohort of critical care patients after severetraumatic brain injury (TBI).Design. This was a prospective observationalstudy. The pituitary function was always tested onthe third day after TBI.Setting. Neurocritical intensive care unit (ICU)in a University hospital.Patients. A total of 136 adult patients with severeTBI (range, 16-65 years) enrolled over a 2year and 9 month period having a stay in the ICUtreated than 48 hours.Intervention. None.Measurements and data collected. The followingdata were recorded within the first 72 hoursafter injury: demographic variables, injury severity,neuromonitoring data, systemic secondarybrain insults, use of vasoactive drugs and type ofTBI according to the computerized tomography (CT) scan findings. Pituitary function was evaluatedby measurement of both the pituitary and targetorgan hormones, with the exception of the somatotrophicfunction, which was assessed bymeasurement of basal serum values of insulinlikegrowth factor-I (IGF-I).Results. Pituitary dysfunction was observed in101 patients (74.2%). Seventy-nine patients (58%)had impairment of only one pituitary axis, the axesbeing affected as follows: gonadotropic 63.7%(87 patients), thyrotropic 8.8% (12 patients) andcorticotropic 0.7% (1 patient). Low IGF-1 plasmaticlevels in accordance to the patient’s age wereobserved in 90 patients (66.7%). However, only 26of them had a value below 90 ng/ml.Conclusions. Our data show that pituitary dysfunctionoccurs early and with high frequency aftersevere TBI, but the real significance of thesefindings still needs to be elucidated

Brain death after severe traumatic brain injury: the role of systemic secondary brain insults.

Secondary brain insults predominantly due to hypotension are frequent among patients with fatal traumatic brain injury. We assessed the correlation between different systemic secondary brain insults and brain death in 404 patients admitted to our intensive care unit (ICU) after severe traumatic brain injury. We collated data on hypoxemia and hypotension prior to as well as the occurrence of hypoxemia, hypotension, shock, anemia, hyperglycemia, and hyperthermia within the first 24 hours after ICU admission. We also considered both the presence of extracranial injuries and the category of traumatic brain injury using computerized tomography. The 59 patients (14.6%) who developed brain death, were significantly older than patients without a fatal neurological outcome (46.1 +/- 22 vs 29.5 +/- 14.9 years; P < .0001). Intracranial mass lesions, whether surgically evacuated were more frequent among brain-dead patients. The systemic secondary brain insults significantly associated with brain death were hypoxemia, hypotension, shock, anemia, and hyperglycemia within the first 24 hours after ICU admission. After multivariate analysis, the factors that independently predicted brain death were the occurrence of shock (odds ratio [OR], 6.74; 95% confidence interval [CI], 2.85-15.84; P = .001) and older age (OR, 1.05; 95% CI, 1.03-1.07; P = .003). In conclusion, early shock seems to be the major systemic secondary brain insult associated with brain death in patients with severe traumatic brain injury. Prevention of or correction of shock might help to either decrease the occurrence of a fatal neurological outcome or in brain-dead patients to preserve organs in better condition for procurement.

Neumonía comunitaria grave por legionella pneumophila / Severe community-acquired pneumonia due to legionella pneumophila

Legionella pneumophila (LP) es la segunda causa de neumonía comunitaria en nuestro medio, y un elevado porcentaje de casos precisan ingreso en unidades de cuidados intensivos (UCI), con una elevada mortalidad. Presentamos 3 casos de neumonía comunitaria grave (NCG) por LP. El motivo de ingreso en todos los casos fue insuficiencia respiratoria. Al ser tanto la clínica como la radiología torácica inespecíficas, se llegó al diagnóstico mediante pruebas complementarias, siendo positivas las antigenurias para LP en los tres pacientes y sólo en dos de los casos la serología era positiva para el serogrupo 1. Se realizó tratamiento antimicrobiano empírico con fluoroquinolonas (levofloxacino) y cefalosporinas de tercera generación (ceftriaxona). Dos pacientes presentaron una mala evolución clínica, desarrollando un cuadro de disfunción multiorgánica, motivo finalmente de los fallecimientos. El tercer caso evolucionó de manera favorable, siendo dado de alta a las 48 horas del ingreso. (AU)

El infarto de miocardio en el diabético: implicaciones clínicas, pronósticas y terapéuticas en la era trombolítico-intervencionista / Myocardial infarction in diabetics: clinical, prognostic and therapeutic implications in the thrombolyticinterventionist era

Objetivo. El propósito de esta revisión es analizar la información generada en la actual era trombolítico-intervencionista con respecto a las implicaciones clínicas, pronósticas y terapeúticas del paciente diabético con infarto de miocardio. Fuente de datos. Búsqueda bibliográfica mediante la base de datos MEDLINE desde 1966 hasta 2000. Se usó metodología booleana usando los términos: infarto agudo de miocardio, diabetes mellitus, pronóstico, angioplastia coronaria transluminal percutánea y cirugía de injerto coronario. Por su relevancia se seleccionaron 88 estudios. Resultados. El aumento de la morbilidad y la mortalidad en el infarto del diabético se explica por el peor perfil basal de riesgo y por las mayores tasas de reinfarto y fallo cardíaco de estos pacientes. Los diabéticos con infarto se benefician particularmente de la administración de trombolíticos, bloqueadores beta, inhibidores de la enzima conversiva de la angiotensina y de un estricto control glucometabólico. Debido a la afectación más difusa de los vasos coronarios y a la aterogénesis más acelerada, los diabéticos presentan peores resultados con las técnicas de revascularización que los no diabéticos. Aunque no está definitivamente establecido, en diabéticos con afectación multivaso la revascularización quirúrgica ha demostrado ser superior a la percutánea. El papel del stent y de los antagonistas de las glucoproteínas plaquetarias IIb/IIIa para optimizar los resultados de la angioplastia en el diabético, aunque prometedor, está pendiente de confirmación. Conclusión. Los diabéticos que sufren un infarto de miocardio deben ser considerados per se como de alto riesgo y, por esta misma razón, se benefician más que los no diabéticos de las modernas intervenciones farmacológicas y revascularizadoras. En el momento actual, están en marcha estudios aleatorizados que permitirán definir en los próximos años cuál será la estrategia de revascularización y la medicación coadyuvante más efectiva en estos pacientes (AU)

A high-throughput AFLP-based method for constructing integrated genetic and physical maps: progress toward a sorghum genome map.

Sorghum is an important target for plant genomic mapping because of its adaptation to harsh environments, diverse germplasm collection, and value for comparing the genomes of grass species such as corn and rice. The construction of an integrated genetic and physical map of the sorghum genome (750 Mbp) is a primary goal of our sorghum genome project. To help accomplish this task, we have developed a new high-throughput PCR-based method for building BAC contigs and locating BAC clones on the sorghum genetic map. This task involved pooling 24,576 sorghum BAC clones ( approximately 4x genome equivalents) in six different matrices to create 184 pools of BAC DNA. DNA fragments from each pool were amplified using amplified fragment length polymorphism (AFLP) technology, resolved on a LI-COR dual-dye DNA sequencing system, and analyzed using Bionumerics software. On average, each set of AFLP primers amplified 28 single-copy DNA markers that were useful for identifying overlapping BAC clones. Data from 32 different AFLP primer combinations identified approximately 2400 BACs and ordered approximately 700 BAC contigs. Analysis of a sorghum RIL mapping population using the same primer pairs located approximately 200 of the BAC contigs on the sorghum genetic map. Restriction endonuclease fingerprinting of the entire collection of sorghum BAC clones was applied to test and extend the contigs constructed using this PCR-based methodology. Analysis of the fingerprint data allowed for the identification of 3366 contigs each containing an average of 5 BACs. BACs in approximately 65% of the contigs aligned by AFLP analysis had sufficient overlap to be confirmed by DNA fingerprint analysis. In addition, 30% of the overlapping BACs aligned by AFLP analysis provided information for merging contigs and singletons that could not be joined using fingerprint data alone. Thus, the combination of fingerprinting and AFLP-based contig assembly and mapping provides a reliable, high-throughput method for building an integrated genetic and physical map of the sorghum genome.