Mortality after emergency department discharge: an analysis of 453599 cases. / Mortalidad tras el alta desde el servicio de urgencias hospitalario: análisis de 453.599 episodios.

OBJECTIVES: To quantify and analyze mortality in patients who die within 30 days of discharge home from a hospital emergency department (ED). MATERIAL AND METHODS: All patients older than 14 years of age who were discharged home from the ED of a tertiary care hospital over a 5-year period were included. We collected age, sex, and other demographic variables, as well as the Charlson Comorbidity Index (CCI). The outcome variables of interest were 7-day and 30-day mortality and cause of death. Deaths were classified as expected and directly related to the emergency, expected but not directly related, unexpected and directly related, and unexpected and not directly related. A death was classified as an adverse event if it was directly related to a problem of diagnosis or management in the ED, underestimation of severity, or complications of a procedure. RESULTS: Of 519312 patients attended in the ED, 453 599 were discharged home. Of those discharged, 148 died at home within 7 days (32.63 deaths/100 000 discharges) and 355 died within 30 days (78.48 deaths/100 000 discharges). One hundred thirteen deaths (31.8%) were expected and related to the emergency 24.91/100 000), 169 (47.6%) were expected but unrelated 37.26/100 000), 4 (1.1%) were unexpected and related 1.10/100000), and 69 (19.4%) were unexpected and unrelated 15.21/100000). Deaths were considered adverse events related to ED care in 24.2% of the cases. Underestimation of severity was responsible for the highest proportion (10.7%) of such deaths. The median age of patients who died was 83 years, and the median Charlson comorbidity index (CCI) was 6. The most common cause of death was a malignant tumor (23.0%), followed by congestive heart failure (20.2%) and atherosclerotic cardiovascular disease (13.2%). Unexpected deaths related to ED care were significantly related to a higher proportion of adverse events related to diagnosis (P = .001), management (P = .004), and underestimation of severity (P .001). CONCLUSION: Early deaths after discharge home from a hospital ED occured in patients of advanced age with concomitant conditions. The main clinical settings were neoplastic and cardiovascular disease. Seven-day and 30-day mortality rates directly related to the emergency visit were low. Adverse events related to ED care played a role in about a quarter of the deaths after discharge.

OBJETIVO: Cuantificar y analizar la mortalidad de los pacientes dados de alta directamente desde un servicio de urgencias hospitalario (SUH) y que fallecen dentro de los primeros 30 días en el domicilio. METODO: Se incluyeron todos los pacientes mayores de 14 años dados de alta desde el SUH a domicilio durante 5 años en un hospital terciario. Se recogieron como variables demográficas, edad, sexo e índice de Charlson. Como variable evolutiva se investigó la mortalidad a 30 días, y si esta ocurrió en 7 o menos días o más de 7 días y la causa del fallecimiento. La mortalidad se clasificó como esperada y directamente relacionada, esperada y no directamente relacionada, no esperada y directamente relacionad, y no esperada y no directamente relacionada. Se determinó como evento adverso (EA) relacionada con la mortalidad si la muerte estaba relacionada con un problema diagnóstico o de manejo, de infraestimación de la gravedad o complicaciones del procedimiento. RESULTADOS: Fueron atendidos 519.312 episodios de los que 453.599 fueron dados de alta al domicilio. De estos, 148 fallecieron en domicilio a los 7 días (32,63/100.000 altas) y 355 fallecieron en los 30 días después del alta (78,48/100.000 altas): el 31,8% (n = 113) fueron fallecimientos esperados y relacionados (24,91/100.000 altas), el 47,6% (n = 169) esperados y no relacionados (37,26/100.000 altas), el 1,1% (n = 4) no esperados y relacionados (1,10/100.000 altas) y 19,4% (n = 69) no esperados y no relacionados (15,21/100.000 altas). En un 24,2% de los pacientes se detectaron EA relacionados con la asistencia en urgencias, el más frecuente EA fue la infraestimación de la gravedad (10,7%). La mediana de edad de los pacientes fallecidos era de 83 años y una mediana del índice de comorbilidad de Charlson (ICC) de 6 puntos. La principal etiología de fallecimiento fue la neoplasia maligna (23,0%), seguida de insuficiencia cardiaca congestiva (20,2%) y enfermedad cardiaca arteriosclerótica (13,2%). En los fallecimientos no esperados y relacionados, destaca una mayor proporción de EA por causa de problemas diagnósticos (p = 0,015), de manejo (p = 0,028) y de infraestimación de la gravedad (p = 0,004). CONCLUSIONES: Los pacientes que fallecen de forma precoz tras el alta de SUH en el domicilio son ancianos con comorbilidad y donde las principales causas de muerte son las enfermedades neoplásicas y las enfermedades cardiacas. Las muertes no esperadas y directamente relacionadas son poco frecuentes a los 7 y 30 días del alta. En una cuarta parte de los pacientes se detectaron EA relacionados con la asistencia en urgencias.

Population Pharmacokinetics of Sertraline in Psychiatric and Substance Use Disorders.

This study aimed to characterize the population pharmacokinetics of sertraline in Mexican patients with psychiatric and substance use disorders. Fifty-nine patients (13 to 76 years old) treated with doses of sertraline between 12.5 and 100 mg/day were included. Plasma sertraline concentrations were determined in blood samples and five of the main substances of abuse were determined by rapid tests in urine samples. Demographic, clinical, and pharmacogenetic factors were also evaluated. Population pharmacokinetic analysis was performed using NONMEM software with first-order conditional estimation method. A one-compartment model with proportional residual error adequately described the sertraline concentrations versus time. CYP2D6*2 polymorphism and CYP2C19 phenotypes significantly influenced sertraline clearance, which had a population mean value of 66 L/h in the final model. The absorption constant and volume of distribution were fixed at 0.855 1/h and 20.2 L/kg, respectively. The model explained 11.3% of the interindividual variability in sertraline clearance. The presence of the CYP2D6*2 polymorphism caused a 23.1% decrease in sertraline clearance, whereas patients with intermediate and poor phenotype of CYP2C19 showed 19.06% and 48.26% decreases in sertraline clearance, respectively. The model was internally validated by bootstrap and visual predictive check. Finally, stochastic simulations were performed to propose dosing regimens to achieve therapeutic levels that contribute to improving treatment response.

Development and evaluation of ciprofloxacin local controlled release materials based on molecularly imprinted polymers.

The aim of this study was the molecular imprinting polymers (MIPs) assessment as a controlled release system of ciprofloxacin. The MIPs synthesis was performed by three different methods: emulsion, bulk, and co-precipitation. Lactic acid (LA) and methacrylic acid (MA) were used as functional monomers and ethylene glycol dimethacrylate as crosslinker. Also, nonimprinted polymers (NIPs) were synthesized. MIPs and NIPs were characterized by scanning electron microscopy, Fourier Transform Infrared Reflection, specific surface area, pore size, and release kinetics. Their efficiency against Staphylococcus aureus and Escherichia coli, and their cytotoxicity in dermal fibroblast cells were proven. Results show that MIPs are mesoporous materials with a pore size between 10 and 20 nm. A higher adsorption with the co-precipitation MIP with MA as a monomer was found. The release kinetics proved that a non-Fickian process occurred and that the co-precipitation MIP with LA presented the highest release rate (90.51 mg/L) in 8 h. The minimum inhibitory concentration was found between 0.031 and 0.016 mg/L for Staphylococcus aureus and between 0.004 and 0.031 mg/L for the Escherichia coli. No cytotoxicity in cellular cultures was found; also, cellular growth was favored. This study demonstrated that MIPs present promising properties for drug administration and their application in clinical practice.

Novel Aspects of cAMP-Response Element Modulator (CREM) Role in Spermatogenesis and Male Fertility.

Spermatogenesis is a very complex process with an intricate transcriptional regulation. The transition from the diploid to the haploid state requires the involvement of specialized genes in meiosis, among other specific functions for the formation of the spermatozoon. The transcription factor cAMP-response element modulator (CREM) is a key modulator that triggers the differentiation of the germ cell into the spermatozoon through the modification of gene expression. CREM has multiple repressor and activator isoforms whose expression is tissue-cell-type specific and tightly regulated by various factors at the transcriptional, post-transcriptional and post-translational level. The activator isoform CREMτ controls the expression of several relevant genes in post-meiotic stages of spermatogenesis. In addition, exposure to xenobiotics negatively affects CREMτ expression, which is linked to male infertility. On the other hand, antioxidants could have a positive effect on CREMτ expression and improve sperm parameters in idiopathically infertile men. Therefore, CREM expression could be used as a biomarker to detect and even counteract male infertility. This review examines the importance of CREM as a transcription factor for sperm production and its relevance in male fertility, infertility and the response to environmental xenobiotics that may affect CREMτ expression and the downstream regulation that alters male fertility. Also, some health disorders in which CREM expression is altered are discussed.

Characterization of the promoter region of the murine Catsper2 gene.

CATSPER2 (Cation channel sperm-associated protein 2) protein, which is part of the calcium CATSPER channel located in the membrane of the flagellar principal piece of the sperm cell, is only expressed in the testis during spermatogenesis. Deletions or mutations in the Catsper2 gene are associated with the deafness-infertility syndrome (DIS) and non-syndromic male infertility. However, the mechanisms by which Catsper2 is regulated are unknown. Here, we report the characterization of the promoter region of murine Catsper2 and the role of CTCF and CREMτ in its transcription. We report that the promoter region has transcriptional activity in both directions, as determined by observing luciferase activity in mouse Sertoli and GC-1 spg transfected cells. WGBS data analysis indicated that a CpG island identified in silico is non-methylated; Chromatin immunoprecipitation (ChIP)-seq data analysis revealed that histone marks H3K4me3 and H3K36me3 are present in the promoter and body of the Catsper2 gene respectively, indicating that Catsper2 is subject to epigenetic regulation. In addition, the murine Catsper2 core promoter was delimited to a region between -54/+189 relative to the transcription start site (TSS), where three CTCF and one CRE binding site were predicted. The functionality of these sites was determined by mutation of the CTCF sites and deletion of the CRE site. Finally, ChIP assays confirmed that CREMτ and CTCF bind to the Catsper2 minimal promoter region. This study represents the first functional analysis of the murine Catsper2 promoter region and the mechanisms that regulate its expression.

["Follow up" strategy in the management of hospital stay]. / Estrategia de Follow up en la gestión de la estancia hospitalaria.

Background: In countries with emerging economies, the adequate and efficient management of resources is a priority, through strategies to reduce prolonged stay, increase the availability of beds, maximize profitability and reduce iatrogenic complications. Objective: The purpose of the study was to evaluate the effect of the "Follow up" strategy (FU) on the main indicators of the hospitalization process. Material and methods: A cross-sectional, comparative study was developed to evaluate the impact of the FU strategy on the indicators: hospital admissions and discharges, average days of hospital stay (DEH), percentage of hospital occupancy (OH), bed substitution interval (ISC), bed turnover rate (CRI) and prolonged hospital stay (EHP). Results: The FU was associated with a reduction in DEH [5.7 (5.5-6.1) vs. 6.5 days (6.1-6.9), p = 0.01]; ISC [0.6 (0.4-0.8) vs. 1.2 (0.8-1.3), p = 0.01] and EHP [23.6 (21.6-24.7) vs. 26.3% (24.4-28.7), p = 0.02] compared to the control group, with an increase in existence [1436 (1381-1472) vs. 1347 patient days (1280-1402), p = 0.02], respectively. There was no significant difference in the number of admissions, discharges or in the IRC. Conclusions: The FU reduces the average number of days of hospital stay, the rate of bed substitution and prolonged stay.

Introducción: en los países con economías emergentes es prioritaria la gestión adecuada y eficiente de los recursos hospitalarios. Las estrategias de gestión pueden reducir la estancia prolongada, aumentar la disponibilidad de camas, maximizar la rentabilidad y reducir las complicaciones iatrogénicas. Objetivo: el propósito del estudio fue evaluar el efecto de la estrategia de Follow up (FU) en los principales indicadores del proceso de hospitalización. Material y métodos: se desarrolló un estudio transversal, comparativo, para evaluar el impacto de la estrategia de FU en los indicadores: ingresos y egresos hospitalarios, promedio de días de estancia hospitalaria (DEH), porcentaje de ocupación hospitalaria (OH), intervalo de sustitución de camas (ISC), índice de rotación de camas (IRC) y estancia hospitalaria prolongada (EHP). Resultados: la estrategia de FU se asoció con una reducción de los DEH [5.7 (5.5-6.1) frente a 6.5 días (6.1-6.9), p = 0.01]; ISC [0.6 (0.4-0.8) frente a 1.2 (0.8-1.3), p = 0.01] y EHP [23.6 (21.6-24.7) frente a 26.3% (24.4-28.7), p = 0.02] respecto al grupo control, con incremento de la existencia [1436 (1381-1472) frente a 1347 días paciente (1280-1402), p = 0.02], respectivamente. No hubo diferencia significativa en el número de ingresos, egresos ni en el IRC. Conclusiones: la estrategia de FU disminuyó el promedio de días de estancia hospitalaria, el índice de sustitución de camas y la estancia prolongada.

UVR Exposure and Prevention of Street Construction Workers in Colombia and Germany.

(1) Solar ultraviolet radiation (UVR) poses a major risk factor for developing skin cancer after years of chronic exposure. The irradiation is strongly dependent upon the activity or occupation carried out, but also on the climate conditions at the workplace. Knowledge of both has been tested within the occupational group of road construction workers in Colombia and Germany. (2) The GENESIS-UV measurement system has been used at both locations for consistency. A number of workers in both countries wore an electronic data logging dosimeter for several months to deliver detailed information on UVR exposure. (3) It was found that in a tropical climate, UVR exposure remains constant throughout the year, while in a temperate climate seasonal effects are visible, superimposed by behavioural aspects e.g., in springtime. The daily distribution of the radiation shows a distinct dip, especially in the Colombian data. Derived data show the high fraction of working days exceeding a threshold set by the skin type. (4) Road construction work involves high UVR exposure. In both countries, preventive measures are required to reduce the personal exposure to a minimum. Exceedance of the minimal erythema dose (MED) suggests a possible enhancing effect, especially in fair skinned people. Intercomparison of UVR exposure at workplaces is possible between countries and climate zones, emphasizing efforts for global action against skin cancer.

End-of-life management of single-use baby diapers: Analysis of technical, health and environment aspects.

Single-use baby diapers belongs to an important group of products used in the parenting journey because of their high performance and convenience. Single-use baby diapers are normally thrown away after one-time use, resulting in a waste management problem. The goal of this paper was to better understand main environmental concerns of different types of diapers and address how to reduce them, with a special consideration of waste management strategies and user behaviour practices. Furthermore, health and environmental hazards potentially associated with materials included in diapers, or substances formed from diapers during the waste treatment stage, are also analysed (e.g., phthalates, pesticides, dioxins, pesticides). Three main types of baby diapers have been analysed: single-use baby diapers, reusable baby diapers, and biodegradable single-use diapers. Each type of diaper comes with technical characteristics and environmental concerns and challenges, which are discussed in this paper to support the development of measures for the safe(r) and sustainable design, use and end of life management of baby diapers.

An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department.

To evaluate the effectiveness of an integrated emergency department (ED)/hospital at home (HH) medical care model in mild COVID-19 pneumonia and evaluate baseline predictors of major outcomes and potential savings. Retrospective cohort study with patients evaluated for COVID-19 pneumonia in the ED, from March 3 to April 30, 2020. All of them were discharged home and controlled by HH. The main outcomes were ED revisit and the need for deferred hospital admission (protocol failure). Outcome predictors were analyzed by simple logistic regression model (OR; 95% CI). Potential savings of this medical care model were estimated. Of the 377 patients attended in the ED, 109 were identified as having mild pneumonia and were included in the ED/HH medical care model. Median age was 50.0 years, 52.3% were males and 57.8% had Charlson index ≥ 1. The median HH stay was 8 (IQR 3.7-11) days. COVID-19-related ED revisit was 19.2% (n = 21) within 6 days (IQR 3-12.5) after discharge from ED. Overall protocol failure (deferred hospital admission) was 6.4% (n = 7), without ICU admission. The ED/HH model provided potential cost savings of 77% compared to traditional stay, due to the costs of home care entails 23% of the expenses generated by a conventional hospital stay. 789 days of hospital stay were avoided by HH, rather than hospital admission. An innovative ED/HH model for selected patients with mild COVID-19 pneumonia is feasible, safe and effective. Less than 6.5% of patients requiring deferred hospital admission and potential savings were generated due to hospitalization.

Atmospheric Methane Concentration Allows Estimating Natural Gas Leaks in Heating Systems in Tandil, Argentina.

Residential use of natural gas (NG) for heating and cooking purposes may contribute significantly to CH emissions to the atmosphere. To analyze whether the NG demand in the city of Tandil, Argentina, contributes to the increase in atmospheric CH concentration, we conducted systematic collections of time-integrated air samples for a year in six city sites with different population and built-up density. Some meteorological parameters and NG consumption were registered. Atmospheric CH concentration ranged from 1.12 to 1.95 mg m (1.72 to 2.84 ppm) with significant seasonal and spatial variations. In all the sites, with the exception of a peri-urban site bordering rural areas, the maximum CH concentrations were measured during the coldest months, with a statistically significant correlation between residential and commercial NG consumption with respect to air temperature ( < 0.001, = -0.84 to -0.69) and atmospheric CH concentration ( < 0.05, = 0.58 to 0.94). In Argentina, the most popular home heating system is the balanced-draft heater, which has a thermal efficiency of 39 to 63%. This low efficiency allows us to attribute the highest atmospheric CH concentration found during the coldest months mainly to the leaks of the heating systems and the greater residential use of NG. Repairing the gas leaks by increasing thermal efficiency or replacing heating systems with more efficient ones will bring economic, environmental, and health benefits. This study is important for our country where the dependence on the use of NG from heating systems is significant.

Estigma: la relevancia del contacto social en el trastorno mental / Stigma: The relevance of social contact in mental disorder

Introducción: El estigma asociado a la enfermedad mental es un problema de salud, discriminando y limitando las oportunidades de las personas que lo padecen. El contacto social con personas que sufren un trastorno mental es una estrategia utilizada para producir cambios en los estereotipos en la población. El objetivo del estudio fue examinar las diferencias en el nivel de estigma en muestras con contacto social y población general. Método: El estudio incluye dos experiencias. La primera (n=42) incluye jugadores de una liga de fútbol abierta en la que juega un equipo de jugadores con diagnóstico de esquizofrenia. En la segunda se compara una muestra sin contacto conocido (n=62) y una muestra con contacto (n=100). La herramienta utilizada de evaluación fue el AQ-27, en versión española (AQ-27-E). Se analizaron la diferencia de medias entre las dos muestras, de cada una de las 9 subescalas. Resultados: En la primera experiencia, todas las subescalas presentaron menor puntuación en poscontacto que en precontacto, excepto responsabilidad, dos subescalas que mostraron diferencias significativas fueron coacción (t=6,057, p= 0,000) y piedad (t=3,661, p= 0,001). En la segunda experiencia, siete subescalas mostraron nivel de significación (p=< 0,05). Responsabilidad y segregación no lo mostraron. Conclusiones: Se observa que el contacto social realizado en entornos cotidianos puede producir un impacto positivo en la reducción del estigma, esto puede contribuir a favorecer la igualdad de oportunidades (AU)

Introduction: The stigma associated with mental illness is a health problem, discriminating and limiting the opportunities for sufferers. Social contact with people suffering a mental disorder is a strategy used to produce changes in population stereotypes. The aim of the study was to examine differences in the level of stigma in samples with social contact and the general population. Method: The study included two experiments. The first (n=42) included players in an open football league who played in a team with players with schizophrenia. In the second included, a sample without known contact (n=62) and a sample with contact (n=100) were compared. The evaluation tool used was AQ-27, Spanish version (AQ-27-E). The mean difference between the two samples of each of the 9 subscales was analyzed. Results: In the first experiment, all the subscales had lower scores in post-contact than in pre-contact, except for responsibility. The two subscales that showed significant differences were duress (t=6.057, p=.000) and Pity (t=3.661, p=.001). In the second experiment, seven subscales showed a significance level (p=<.05). Segregation and responsibility and did not. Conclusions: It is observed that the social contact made in daily situations can have a positive impact on the reduction of stigma. This can help to promote equality of opportunity (AU)

Stigma: The relevance of social contact in mental disorder. / Estigma: la relevancia del contacto social en el trastorno mental.

INTRODUCTION: The stigma associated with mental illness is a health problem, discriminating and limiting the opportunities for sufferers. Social contact with people suffering a mental disorder is a strategy used to produce changes in population stereotypes. The aim of the study was to examine differences in the level of stigma in samples with social contact and the general population. METHOD: The study included two experiments. The first (n=42) included players in an open football league who played in a team with players with schizophrenia. In the second included, a sample without known contact (n=62) and a sample with contact (n=100) were compared. The evaluation tool used was AQ-27, Spanish version (AQ-27-E). The mean difference between the two samples of each of the 9 subscales was analyzed. RESULTS: In the first experiment, all the subscales had lower scores in post-contact than in pre-contact, except for responsibility. The two subscales that showed significant differences were duress (t=6.057, p=.000) and Pity (t=3.661, p=.001). In the second experiment, seven subscales showed a significance level (p=<.05). Segregation and responsibility and did not. CONCLUSIONS: It is observed that the social contact made in daily situations can have a positive impact on the reduction of stigma. This can help to promote equality of opportunity.

Pielopastia Laparoscópica: Técnica Robótica / Laparoscopic pyeloplasty: Robotic Technique

Múltiples series de pieloplastia laparoscópica han demostrado altos niveles de éxito y escasas complicaciones para población adulta. El uso de robótica facilita la reconstrucción pieloureteral debido a la superioridad en cuanto a visión estereoscópica, precisión de movimientos y filtros anti temblor . Lo que permite además del éxito quirúrgico, una ventaja en términos de técnica mínimamente invasiva y consecuentemente menor estadía hospitalaria. El objetivo del presente video es demostrar la técnica utilizada en nuestro centro para pieloplastia robótica y mostrar una sistematización que simplifica el procedimiento.AU

Multiple series of laparoscopic pyeloplasty have demonstrated high success levels and few complications in the adult population. The use of robotics facilitates pyeloureteral reconstruction due to the superiority in stereoscopic vision, movement precision and anti-tremor filters. The previous provides not only surgical success but also an advantage in terms of minimally invasive technique and consequently less hospital stay. The objective of this video is to demonstrate the technique used in our facilities in robotic pyeloplasty and to show a systematization that simplifies the procedure.

Frecuencia, susceptibilidad antimicrobiana y patrón de adherencia de Salmonella enterica aislada de carne de pollo, res y cerdo de la Ciudad de México / Frequency, antimicrobial susceptibility and adherence patterns of Salmonella enterica isolated from chicken meat, beef and pork from Mexico City

Resumen Introducción: Los alimentos de origen animal frecuentemente están implicados en brotes de salmonelosis. Objetivo: Evaluar la frecuencia de Salmonella enterica en carnes molidas de pollo, res y cerdo (un total de 2.592 muestras) obtenidas de mercados sobre ruedas y supermercados de la Delegación Iztapalapa en la Ciudad de México, determinar la susceptibilidad antimicrobiana y efectuar ensayos de adherencia en las cepas aisladas. Métodos: El aislamiento de S. enterica se hizo de acuerdo a la BAM-FDA, la susceptibilidad antimicrobiana de acuerdo con CLSI y el ensayo de adherencia en células HEp-2 conforme a Baffone y cols., 2001. Resultados: Salmonella enterica fue aislada en 511 del total de muestras analizadas (19,7%), de las cuales 244 (47,7%), 152 (29,7%) y 115 (22,5%) correspondieron a carne molida de pollo, res y cerdo, respectivamente. La mayor frecuencia de resistencia de S. enterica a antimicrobianos fue a ampicilina y cloranfenicol en pollo, perfloxacina y ampicilina en res y carbenicilina, ampicilina, cloranfenicol, cefotaxima y perfloxacina en cerdo. Noventa por ciento de las cepas mostraron un patrón de adherencia agregativo. Conclusión: La frecuencia de S. enterica en productos cárnicos es alta, por lo que es importante la adecuada cocción de la carne para disminuir el riesgo de una salmonelosis.

Background: Food of animal origin is often involved in salmonellosis outbreaks. Aim: To evaluate the frequency of Salmonella enterica in chicken, beef and pork ground meat (a total of 2,592 samples) obtained from travelling markets and supermarkets at the Iztapalapa area of Mexico City, in order to determine the antimicrobial susceptibility and adherence capacity of isolated strains. Methods: Isolation of S. enterica was carried out according to the BAM-FDA, the microbial susceptibility according with CLSI and adherence assay on HEp-2 cell line according with Baffone et al., 2001. Results: S. enterica was isolated from 511 of all the analyzed samples (19.7%), from which 244 (47.7%), 152 (29.7%) and 115 (22.5%) corresponded to chicken, beef and pork ground meat, respectively. The highest frequency of resistance of S. enterica to antimicrobials was to ampicillin and chloramphenicol in chicken, perfloxacin and ampicillin in beef and carbenicillin, ampicillin, chloramphenicol, cefotaxime and perfloxacin in pork. Ninety percent of the strains showed an aggregative adherence pattern on HEp-2 cells. Conclusion: The frequency of S. enterica on meat products is high, which is the reason why a proper cooking of these ground meats is important in order to reduce the risk of acquiring salmonellosis.

[Frequency, antimicrobial susceptibility and adherence patterns of Salmonella enterica isolated from chicken meat, beef and pork from Mexico City]. / Frecuencia, susceptibilidad antimicrobiana y patrón de adherencia de Salmonella enterica aislada de carne de pollo, res y cerdo de la Ciudad de México.

BACKGROUND: Food of animal origin is often involved in salmonellosis outbreaks. AIM: To evaluate the frequency of Salmonella enterica in chicken, beef and pork ground meat (a total of 2,592 samples) obtained from travelling markets and supermarkets at the Iztapalapa area of Mexico City, in order to determine the antimicrobial susceptibility and adherence capacity of isolated strains. METHODS: Isolation of S. enterica was carried out according to the BAM-FDA, the microbial susceptibility according with CLSI and adherence assay on HEp-2 cell line according with Baffone et al., 2001. RESULTS: S. enterica was isolated from 511 of all the analyzed samples (19.7%), from which 244 (47.7%), 152 (29.7%) and 115 (22.5%) corresponded to chicken, beef and pork ground meat, respectively. The highest frequency of resistance of S. enterica to antimicrobials was to ampicillin and chloramphenicol in chicken, perfloxacin and ampicillin in beef and carbenicillin, ampicillin, chloramphenicol, cefotaxime and perfloxacin in pork. Ninety percent of the strains showed an aggregative adherence pattern on HEp-2 cells. CONCLUSION: The frequency of S. enterica on meat products is high, which is the reason why a proper cooking of these ground meats is important in order to reduce the risk of acquiring salmonellosis.

Prostatectomía radical: técnica robotica / Radical Prostatectomy: robotic technique

INTRODUCCIÓN: El constante avance de la tecnología y el desarrollo de las técnicas mínimamente invasivas en cirugía robótica han dado mayores opciones de tratamiento quirúrgico a pacientes con Cáncer de Próstata. Debido a la complejidad anatómica y reducido espacio de la pelvis la cirugía robótica facilita realizar la prostatectomía . La superioridad técnica del sistema con robot en cuanto a visión, libertad de movimiento y precisión, permite una cirugía más segura además de mejorar resultados quirúrgicos, oncológicos y funcionales. El objetivo del presente video es demostrar la técnica utilizada en nuestro centro para prostatectomía radical robótica y mostrar una sistematización que simplifica el procedimiento. DESARROLLO: Se exponen las características del instrumento Madajet, así como su carga y armado. Se realiza el aislamiento y superficialización del conducto deferente derecho mediante técnica de tres dedos, en la cual el cirujano coloca sus dedos índice y medio en la cara posterior del escroto, fijando el deferente con el dedo pulgar en la cara anterior de la pared escrotal. Una vez aislado el deferente se realiza la anestesia local mediante del disparo del dispositivo sobre la pared anterior del escroto, repitiendo el proceso sobre el deferente izquierdo. Se realiza vasectomía sin bisturí mediante aislamiento del deferente en el rafe medio escrotal con clamp de anillo Li Brand®, con posterior punción y divulsión de la piel con pinza aguzada Li Brand® . Se efectúa la exteriorización del conducto deferente y posterior separación de éste de los vasos deferenciales, finalizando con la oclusión y sección del deferente. CONCLUSIONES: La vasectomía con técnica sin bisturí ­ sin aguja con dispositivo Madajet es una cirugía sencilla y reproducible que simplifica y disminuye los costos del procedimiento, lo que podría producir una mayor masificación de la vasectomía como método de control de fertilidad.(AU)

Temporal variation in methane emissions in a shallow lake at a southern mid latitude during high and low rainfall periods.

The global methane (CH4) emission of lakes is estimated at between 6 and 16 % of total natural CH4 emissions. However, these values have a high uncertainty due to the wide variety of lakes with important differences in their morphological, biological, and physicochemical parameters and the relatively scarse data from southern mid-latitude lakes. For these reasons, we studied CH4 fluxes and CH4 dissolved in water in a typical shallow lake in the Pampean Wetland, Argentina, during four periods of consecutive years (April 2011-March 2015) preceded by different rainfall conditions. Other water physicochemical parameters were measured and meteorological data were reported. We identified three different states of the lake throughout the study as the result of the irregular alternation between high and low rainfall periods, with similar water temperature values but with important variations in dissolved oxygen, chemical oxygen demand, water turbidity, electric conductivity, and water level. As a consequence, marked seasonal and interannual variations occurred in CH4 dissolved in water and CH4 fluxes from the lake. These temporal variations were best reflected by water temperature and depth of the Secchi disk, as a water turbidity estimation, which had a significant double correlation with CH4 dissolved in water. The mean CH4 fluxes values were 0.22 and 4.09 mg/m2/h for periods with low and high water turbidity, respectively. This work suggests that water temperature and turbidity measurements could serve as indicator parameters of the state of the lake and, therefore, of its behavior as either a CH4 source or sink.

World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile.

Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73-0.92] before and 0.65% (95% CI, 0.57-0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61-0.89]. The median length of stay was 3 days [interquartile range (IQR), 1-5] and 2 days (IQR, 1-4) for the pre and postchecklist period, respectively (P < 0.01).This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries.

Animal Assisted Therapy (AAT) Program As a Useful Adjunct to Conventional Psychosocial Rehabilitation for Patients with Schizophrenia: Results of a Small-scale Randomized Controlled Trial.

Currently, one of the main objectives of human-animal interaction research is to demonstrate the benefits of animal assisted therapy (AAT) for specific profiles of patients or participants. The aim of this study is to assess the effect of an AAT program as an adjunct to a conventional 6-month psychosocial rehabilitation program for people with schizophrenia. Our hypothesis is that the inclusion of AAT into psychosocial rehabilitation would contribute positively to the impact of the overall program on symptomology and quality of life, and that AAT would be a positive experience for patients. To test these hypotheses, we compared pre-program with post-program scores for the Positive and Negative Syndrome Scale (PANSS) and the EuroQoL-5 dimensions questionnaire (EuroQol-5D), pre-session with post-session salivary cortisol and alpha-amylase for the last four AAT sessions, and adherence rates between different elements of the program. We conducted a randomized, controlled study in a psychiatric care center in Spain. Twenty-two institutionalized patients with chronic schizophrenia completed the 6-month rehabilitation program, which included individual psychotherapy, group therapy, a functional program (intended to improve daily functioning), a community program (intended to facilitate community reintegration) and a family program. Each member of the control group (n = 8) participated in one activity from a range of therapeutic activities that were part of the functional program. In place of this functional program activity, the AAT-treatment group (n = 14) participated in twice-weekly 1-h sessions of AAT. All participants received the same weekly total number of hours of rehabilitation. At the end of the program, both groups (control and AAT-treatment) showed significant improvements in positive and overall symptomatology, as measured with PANSS, but only the AAT-treatment group showed a significant improvement in negative symptomatology. Adherence to the AAT-treatment was significantly higher than overall adherence to the control group's functional rehabilitation activities. Cortisol level was significantly reduced after participating in an AAT session, which could indicate that interaction with the therapy dogs reduced stress. In conclusion, the results of this small-scale RCT suggest that AAT could be considered a useful adjunct to conventional psychosocial rehabilitation for people with schizophrenia.

Edentulismo en adultos de Pachuca, México: aspectos sociodemográficos y socioeconómicos / Edentulism in Mexican adults: sociodemographic and socioeconomic aspects

Introducción La pérdida de dientes se ha convertido en un problema de salud pública bucal. Objetivo Determinar la prevalencia y distribución del edentulismo, así como las variables sociodemográficas y socioeconómicas asociadas en individuos de 35 años y más. Materiales y métodos Se realizó un estudio transversal en 656 sujetos seleccionados de forma aleatoria. En el estudio se incluyeron hombres y mujeres de 35 años y más, asistentes a las clínicas de atención dental de la Universidad Autónoma del Estado de Hidalgo (UAEH), una universidad pública de México. Para la realización de este estudio los examinadores fueron capacitados en la cumplimentación de los cuestionarios y estandarizados en el criterio diagnóstico de la pérdida de dientes. La variable dependiente fue el edentulismo. Los datos fueron analizados en Stata 11. Resultados El promedio de edad fue de 49,06 ± 10,33. Los individuos fueron principalmente mujeres (63,3%). La prevalencia general de edentulismo fue de 15,7% (IC 95%: 12,9-18,5); entre las mujeres fue de 17,6% y en los hombres de 12,5% (p = 0,081). La prevalencia de edentulismo fue mayor entre los sujetos de más edad (p < 0,001). Se observó que a mayor escolaridad (p < 0,001), a mejor nivel socioeconómico (p < 0,001) y en quienes tuvieron automóvil en el hogar (p < 0,05), la prevalencia de edentulismo fue menor. Conclusiones La prevalencia de edentulismo en adultos mayores de 35 años que acuden a las clínicas de esta universidad fue del 15,7%. Se observó diferencia de la prevalencia de edentulismo por edad, pero no por sexo. Se observaron diferencias socioeconómicas, sugiriendo ciertas desigualdades en salud bucal.

Introduction Tooth loss has become a problem of oral health. Objective To determine the prevalence and distribution of edentulism, as well as the associated sociodemographic and socioeconomic variables in subjects aged 35 and older. Materials and methods A cross-sectional study was conducted on 656 randomly selected subjects. The study included men and women aged 35 years and older attending dental care clinics at a public university in Mexico. Examiners were trained in filling out questionnaires and receiving training in order to standardise the criteria of tooth loss. The dependent variable was the presence of edentulism. The data were analysed using Stata 11. Results The mean age of the population was 49.06 ± 10.33 years, and the majority (63.3%) were women. The overall prevalence of edentulism was 15.7% (95% CI: 12.9-18.5%); the prevalence among women was 17.6% and the prevalence among men was 12.5% (P = .081). The prevalence of edentulism was higher among older subjects (P < .001). The prevalence of edentulism was lower among individuals with higher levels of education (P < .001), those with higher socioeconomic status (P < .001), and those who had a car at home (P < 0.05) Conclusions The prevalence of edentulism in adults over 35 years of age attending dental care clinics at this public university was 15.7%. Differences were observed in the prevalence of edentulism by age, but not by gender. Socioeconomic differences were observed, suggesting certain oral health inequalities.