Recién nacida con flictenas / Newborn with blisters

Presentamos el caso de una recién nacida con flictenas a las 48 horas de vida, que al cicatrizar presentan punteado blanquecino en forma de quistes de milium, por lo que se sospecha la posibilidad de una enfermedad ampollosa congénita. Finalmente, el Servicio de Dermatología confirma el diagnostico de epidermólisis ampollosa de Weber-Cockayne (AU)

The case o a newborn with blisters at 48 hours of life is reported. When healing, dotted whitish scar similar to milium cysts appear, so raising the possibility of a congenital bullous disease. Finally, the Dermatology Department confirms the diagnosis of Epidermolysis bullosa of Weber-Cockayne (AU)

Metabolomic assays of amoxicillin, cephapirin and ceftiofur in chicken muscle: application to treated chicken samples by liquid chromatography quadrupole time-of-flight mass spectrometry.

The aim of this study was to identity metabolites and transformation products (TPs) in chicken muscle from amoxicillin (AMX), cephapirin (PIR) and ceftiofur (TIO), which are antibiotics of the ß-lactam family. Liquid chromatography coupled to quadrupole time-of-flight (QqTOF) mass spectrometry was utilized due to its high resolution, high mass accuracy and MS/MS capacity for elemental composition determination and structural elucidation. Amoxicilloic acid (AMA) and amoxicillin diketopiperazine (DKP) were found as transformation products from AMX. Desacetylcephapirin (DAC) was detected as a metabolite of PIR. Desfuroylceftiofur (DFC) and its conjugated compound with cysteine (DFC-S-Cys) were detected as a result of TIO in contact with chicken muscle tissue. The metabolites and transformation products were also monitored during the in vivo AMX treatment and slaughtering period. It was found that two days were enough to eliminate AMX and associated metabolites/transformation products after the end of administration.

Impacto de los métodos de diagnóstico por imagen en la apendicectomía de urgencia / Impact of imaging tests on the negative appendectomy rate

Introducción. Las apendicectomías negativas y gangrenadas son indicadores de calidad en cirugía general. Los objetivos de este estudio son analizar las apendicectomías de urgencia en relación con el uso de pruebas de imagen y revisar la bibliografía para analizar la calidad del proceso diagnóstico en la apendicitis aguda. Material y métodos. Estudio retrospectivo en el que se incluyeron todos los pacientes a los que se les realizó apendicectomía de urgencia por sospecha de apendicitis aguda en el Hospital Universitario 12 de Octubre de Madrid durante el año 2007. Los datos se obtuvieron de los informes de anatomía patológica y de las pruebas de imagen realizadas. Se analizaron la histología, las pruebas de imagen empleadas y su utilidad diagnóstica. Se compararon con los niveles de calidad publicados en la literatura médica internacional. Resultados. Se incluyeron en el estudio 394 pacientes. La tasa de apendicectomías negativas fue del 9,6%. Se le realizó ecografía (ECO) abdominal al 54,6% de los pacientes y tomografía axial computarizada (TAC) abdominal al 10,2% de los pacientes (TAC+ECO: 4,2%). El valor predictivo positivo de la ECO fue del 92,2% y el de la TAC fue del 97,5%. Conclusión. Las apendicectomías negativas (9,6%) muestran valores inferiores a los publicados históricamente, pero son más elevados que los publicados recientemente en EE. UU. El uso de técnicas de imagen en nuestro medio es inferior al publicado en EE. UU., aunque similar al de otros países europeos(AU)

Introduction. Negative appendectomies and perforated appendectomies have traditionally been quality indicators in surgery. The aim of this study is to analyze the emergency appendectomies in our hospital regarding the use of imaging tests and a review of the literature to analyze the quality of diagnosis in acute appendicitis. Material and methods. Retrospective study including all patients operated on for suspected acute appendicitis at a single institution for one year (2007). Data gathered from histology and imaging tests reports. Analysis of the histology results, imaging test used and its diagnostic accuracy. Comparison with quality levels published in the international literature. Results. A total of 394 patients were included in the study, the overall rate of negative appendectomy was 9.6%. Abdominal ultrasound (AU) was performed on 54.6% of patients and abdominal CT-scan on 10.2% of them, and 4.2% of the patients had both tests. AU positive predictive value was 82%. CT-scan positive predictive value was 97%. Conclusion. The negative appendectomy rate (9.6%) in our centre shows values lower than the published ones in historical series but superior to the one published recently in the USA. The use of imaging tests in our hospital is lower than the one published in the USA, although similar to data reported in other European countries(AU)

[Impact of imaging tests on the negative appendectomy rate]. / Impacto de los métodos de diagnóstico por imagen en la apendicectomía de urgencia.

INTRODUCTION: Negative appendectomies and perforated appendectomies have traditionally been quality indicators in surgery. The aim of this study is to analyze the emergency appendectomies in our hospital regarding the use of imaging tests and a review of the literature to analyze the quality of diagnosis in acute appendicitis. MATERIAL AND METHODS: Retrospective study including all patients operated on for suspected acute appendicitis at a single institution for one year (2007). Data gathered from histology and imaging tests reports. Analysis of the histology results, imaging test used and its diagnostic accuracy. Comparison with quality levels published in the international literature. RESULTS: A total of 394 patients were included in the study, the overall rate of negative appendectomy was 9.6%. Abdominal ultrasound (AU) was performed on 54.6% of patients and abdominal CT-scan on 10.2% of them, and 4.2% of the patients had both tests. AU positive predictive value was 82%. CT-scan positive predictive value was 97%. CONCLUSION: The negative appendectomy rate (9.6%) in our centre shows values lower than the published ones in historical series but superior to the one published recently in the USA. The use of imaging tests in our hospital is lower than the one published in the USA, although similar to data reported in other European countries.

[Arsenic levels in drinking water supplies from underground sources in the community of Madrid]. / Nivel de arsénico en abastecimientos de agua de consumo de origen subterráneo en la comunidad de Madrid.

BACKGROUND: In 1998, arsenic concentrations of more than 50 micrograms/l were detected in some drinking water supplies from underground sources in the Autonomous Community of Madrid, which is the maximum permissible concentration for drinking water in Spain. These two facts have meant the getting under way of a specific plan for monitoring arsenic in the drinking water in the Autonomous Community of Madrid. METHODS: The results of the first two sampling processes conducted in the arsenic level monitoring plan set out are presented. In the initial phase, water samples from 353 water supplies comprised within the census of the Public Health Administration of the Autonomous Community of Madrid were analyzed. A water supply risk classification was made based on these initial results. In a second phase, six months later, the analyses were repeated on those 35 water supplies which were considered to possibly pose a risk to public health. RESULTS: Seventy-four percent (74%) of the water supplies studied in the initial phase were revealed to have an arsenic concentration of less than 10 micrograms/l, 22.6% containing levels of 10 micrograms/l-50 micrograms/l, and 3.7% over 50 micrograms/l. Most of the water supplies showing arsenic levels of more than 10 micrograms/l are located in the same geographical area. In the second sampling process (six months later), the 35 water supplies classified as posing a risk were included. Twenty-six (26) of these supplies were revealed to have the same arsenic level ((10-50 micrograms/l), and nine changed category, six of which had less than 10 micrograms/l and three more than 50 micrograms/l. CONCLUSIONS: In the Autonomous Community of Madrid, less than 2% of the population drinks water coming from supplies which are from underground sources. The regular water quality monitoring conducted by the Public Health Administration has led to detecting the presence of more than 50 micrograms/l of arsenic in sixteen drinking water supplies from underground sources, which is the maximum permissible level under the laws currently in force in Spain. Measures have been taken to prevent water from being used from these water supplies. Around 20% of the water supplies studies must take measures in the near future to lower the arsenic concentration to below 10 micrograms/l when the water directive which is currently in the process of being written into Spanish law enters into effect.

Using the International Classification of Impairments, Disabilities, and Handicaps in surveys: the case of Spain.

A survey was conducted in Spain in 1986 to estimate the number of people with disabilities and to identify the impairments which had given rise to them. The survey also set out to identify the causes of these impairments and to analyse the nature and extent of the handicaps resulting from these impairments and disabilities. The frame of reference for the survey was the WHO International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which was adapted in a number of ways. The most radical departure was to begin the survey with disabilities, which were considered easier to identify. 15% of the population presented a disability, the rate mostly increasing with age, with substantial differences between the sexes and pronounced gradients in relation to socioeconomic status in some cases. Analysis of disabilities and impairments by administrative area also revealed some significant geographical variations. The study of handicaps posed some particularly complex problems of methodology. In conclusion, the work of the Spanish survey was facilitated by the use of the ICIDH, but this classification requires several substantial modifications before it can be systematically used in surveys of this type.