Valoración e indicaciones quirúrgicas: cirugía separación / Preoperative assessment and surgical indications: Separation surgery

La compresión neurológica se presenta entre el 10-20% de los pacientes que desarrollan una metástasis vertebral. En la última década, la evolución de las técnicas diagnósticas y médicas oncológicas, el cambio de la radiación convencional externa a la radiocirugía y los nuevos instrumentales quirúrgicos, han hecho que el tratamiento de estos pacientes deba de ser indicado de forma personalizada y en consenso, de forma multidisciplinar, en comisiones específicas.Hoy, el estado biológico del paciente, la presencia de inestabilidad mecánica, la valoración neurológica y el grado de compresión epidural, así como la mejor categorización pronóstica del tumor, se establecen como los factores de decisión previa a la indicación del tratamiento quirúrgico, tratamiento que ha pasado de un concepto «citorreductor» al de «separador» o «preparador» de la médula para asegurar una radiocirugía segura.(AU)

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions.Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.(AU)

[Translated article] Preoperative assessment and surgical indications: Separation surgery / Valoración e indicaciones quirúrgicas: cirugía de separación

La compresión neurológica se presenta entre el 10-20% de los pacientes que desarrollan una metástasis vertebral. En la última década, la evolución de las técnicas diagnósticas y médicas oncológicas, el cambio de la radiación convencional externa a la radiocirugía y los nuevos instrumentales quirúrgicos, han hecho que el tratamiento de estos pacientes deba de ser indicado de forma personalizada y en consenso, de forma multidisciplinar, en comisiones específicas.Hoy, el estado biológico del paciente, la presencia de inestabilidad mecánica, la valoración neurológica y el grado de compresión epidural, así como la mejor categorización pronóstica del tumor, se establecen como los factores de decisión previa a la indicación del tratamiento quirúrgico, tratamiento que ha pasado de un concepto «citorreductor» al de «separador» o «preparador» de la médula para asegurar una radiocirugía segura.(AU)

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions.Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.(AU)

[Translated article] Preoperative assessment and surgical indications: Separation surgery.

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions. Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.

Preoperative assessment and surgical indications: Separation surgery. / Valoración e indicaciones quirúrgicas: cirugía separación.

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions. Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.

Elevación de seno conBetafosfato Tricálcico yposterior colocación deimplantes. A propósito deun caso / Sinus lift with tricalcium beta-phosphate and subsequent implant placement. Case report

La extracción o pérdida dental supone la remodelación del alveolo y una pérdida progresiva del hueso alveolar residual. Esta disminución en altura, debido a la presencia delseno maxilar en el sector posterosuperior, puede comprometer la disponibilidad ósea adecuada para la colocación de implantes. Como solución a esto, surge la técnica de elevación de seno. En esta técnica, se emplean diversos materiales de injerto, entre los que se encuentran el betafosfatotricálcico (b-TCP). Este material presenta propiedades osteoconductivas y osteoinductivas. Además, se reabsorbe más fácil que otros sustitutos óseos y es fácilmente reemplazado por nuevo hueso. Se ha comparado su comportamiento clínico con otros materiales de injerto, sin encontrar diferencias significativas. Además, a 10 años, los implantes colocados en elevaciones de seno realizadas con b-TCP han mostrado altas tasas de supervivencia. Caso clínico. Se presenta el caso clínico de una paciente, mujer de 52 años de edad, sin antecedentes médicos de interés. Acude a consulta por dolor en el 26. Tras la exploración diagnóstica radiológica e intrabucal se aconsejó a la paciente la extracción del 26. Ocho meses después, y realizando un estudio con CBCT se informó a la paciente sobre la posibilidad de rehabilitación con implantes, previa cirugía de elevación sinusal. Se realizó la elevación sinusal con b-TCP como material de injerto. Pasados tres meses, se procedió a la colocación de tres implantes, adquiriendo estos una buena estabilidad primaria Discusión y conclusiones. Se utilizan diversos materiales de injerto en la técnica de elevación sinusal, injertos de hueso autólogo, xenoinjertos e injerto aloplásticos. Se ha comparado el comportamiento clínico del b-TCP con otros materiales de injerto sin mostrar diferencias significativas. Por otro lado, se ha estudiado un periodo de espera menor a 6 (AU)

Tooth extraction or loss involves alveolar remodelling and progressive loss of residual alveolar bone. This reduction in height, due to the presence of the maxillary sinus in the posterosuperior sector, can compromise adequate bone availability for implant placement. The sinus lift technique has emerged as a solution to this problem. In this technique, various grafting materials are used, including beta-phosphatidic acid (b-TCP). This material has osteoconductive and osteoinductive properties. In addition, it is more easily resorbed than other bone substitutes and is easily replaced by new bone. Its clinical behaviour has been compared with other graft materials, without finding significant differences. In addition, at 10 years, implants placed in sinus lifts performed with b-TCP have shown high survival rates. Clinical case: The clinical case of a 52-year-old female patient with no medical history of interest is presented. She went for consultation due to pain in tooth 26. Following the radiological and intraoral diagnostic examination, the patient was advised to have tooth 26 extracted. Eight months later, and after a CBCT study, the patient was informed about the possibility of rehabilitation with implants, following sinus lift surgery. The sinus lift was performed with b-TCP as graft material. After three months, three implants were placed, acquiring a good primary stability. Discussion and conclusions: different graft materials are used in the sinus lift technique, autologous bone grafts, xenografts and alloplastic grafts. The clinical performance of b-TCP has been compared with no significant differences found. Furthermore, a waiting period of less than 6 months has been studied for the placement of implants. These implants showed high primary stability and survival rates of 99-100%. Therefore, b-TCP is a safe material for sinus lifts and allows the placement of implants in a healing time of less than 6 months (AU)

Sumario de las recomendaciones y puntos clave del Consenso de las Sociedades Científicas Españolas (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP) para la utilización de la ventilación no invasiva y terapia de alto flujo con cánulas nasales en el paciente adulto, pediátrico y neonatal con insuficiencia respiratoria aguda grave / Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure

El soporte respiratorio no invasivo (SRNI) comprende 2 modalidades de tratamiento, la ventilación mecá-nica no invasiva (VMNI) y la terapia de alto flujo con cánulas nasales (TAFCN) que se aplican en pacientes adultos, pediátricos y neonatales con insuficiencia respiratoria aguda (IRA). Sin embargo, el grado de acuerdo entre las distintas especialidades sobre el beneficio de estas técnicas en diferentes escenarios clínicos es controvertido. El objetivo del presente consenso fue elaborar una serie de recomendaciones de buena práctica clínica para la aplicación de soporte no invasivo en pacientes con IRA, avaladas por todas las sociedades científicas involucradas en el manejo del paciente adulto y pediátrico/neonatal con IRA. Para ello se contactó con las diferentes sociedades implicadas, quienes designaron a su vez a un grupo de 26 profesionales con suficiente experiencia en su aplicación. Se realizaron 3 reuniones presenciales para consensuar las recomendaciones (hasta un total de 71) fundamentadas en la revisión de la literatura y en la actualización de la evidencia disponible en relación con 3 categorías: indicaciones, monitorización yseguimiento del SRNI. Finalmente, se procedió a votación telemática de cada una de las recomendaciones, por parte de los expertos de cada sociedad científica implicada. Para la clasificación del grado de acuerdo se optó por un sistema analógico de clasificación fácil e intuitivo de usar, y que expresara con claridad si el procedimiento relacionado con el SRNI debía hacerse, podía hacerse o no debía hacerse. (AU)

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied. (AU)

Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure.

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.

Las plantas medicinales, patrimonio natural y cultural de la Reserva Hídrica Natural y Recreativa Bamba, La Calera, Córdoba, Argentina / Medicinal plants, natural and cultural heritage of the Bamba Natural and Recreational Water Reserve, La Calera, Córdoba, Argentina

Herbal medicine has played a leading role in the health systems of many traditional societies. The main objective is to characterize an aspect of the natural and cultural heritage of a protected area of the town of La Calera, through the documentation of medicinal plants of the Bamba Water and Recreational Nature Reserve (RNHRB), in the province of Córdoba, Argentina. Methodologies of social and natural sciences, typical of ethnoecological approaches, were combined, complementing with qualitative and quantitative analyzes. A total of 221 uses corresponding to 137 medicinal species were documented. The most relevant families in terms of quantity of species and uses are Asteraceae, Fabaceae and Lamiaceae. In all cases the native / wild status predominates. Applications associated with gastrointestinal conditions are the most frequent, followed by dermatological, pneumonological, infectological and nephrological. It is concluded that herbal medicine in protected areas provides valuable information and efforts for the conservation of biocultural heritage in intangible rural areas with urbanized spaces, as well as for the potencial knowledge and use of resources by small local producers.

La medicina herbaria ha desempeñado un papel de liderazgo en los sistemas de salud de muchas sociedades tradicionales. El objetivo principal es caracterizar un aspecto del patrimonio natural y cultural de un área protegida de la localidad de La Calera, a través de la documentación de plantas medicinales de la Reserva Natural Acuática y Recreativa de Bamba (RNHRB), en la provincia de Córdoba, Argentina. Se combinaron metodologías de las ciencias sociales y naturales, propias de los enfoques etnoecológicos, complementando con análisis cualitativos y cuantitativos. Se documentaron un total de 221 usos correspondientes a 137 especies medicinales. Las familias más relevantes en cuanto a cantidad de especies y usos son Asteraceae, Fabaceae y Lamiaceae. En todos los casos predomina el estado nativo/salvaje. Las aplicaciones asociadas a afecciones gastrointestinales son las más frecuentes, seguidas de las dermatológicas, neumonológicas, infecciosas y nefrológicas. Se concluye que la fitoterapia en áreas protegidas brinda valiosa información y esfuerzos para la conservación del patrimonio biocultural en áreas rurales intangibles con espacios urbanizados, así como para el potencial conocimiento y uso de recursos por parte de pequeños productores locales.

[Gonococcal pelviperitonitis: a diagnostic challenge].

Neisseria gonorrhoeae is the second most common etiological agent of pelvic inflammatory disease and is currently un-derdiagnosed due to its asymptomatic presentation in 50% of cases. When the disease presents, it may appear in the form of acute abdomen and normal imaging tests, making it a major diagnostic challenge. We present four cases of acute gonococcal peritonitis. The main symptom was acute abdominal pain, and both the gy-necological examination and complementary tests showed normal results. The only notable finding from the laparoscopy was the existence of purulent ascitic fluid. The results of the anatomical and pathological tests were all normal. Endocer-vical and ascitic fluid culture showed infection with N. gonorrhoeae, and in one case, concomitant infection with Chlamydia trachomatis. The definitive treatment applied was intravenous antibiotic therapy. When a sexually active young woman is diagnosed with peritonitis that has no apparent cause, it is important to rule out sexually transmitted diseases.

Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. / Sumario de las recomendaciones y puntos clave del Consenso de las Sociedades Científicas Españolas (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP) para la utilización de la ventilación no invasiva y terapia de alto flujo con cánulas nasales en el paciente adulto, pediátrico y neonatal con insuficiencia respiratoria aguda grave.

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.

Biopsia renal. Descripción clinicopatológica, complicaciones y evolución en un hospital general del Perú / Kidney Biopsy. Clinicopathological Description, Complications And Evolution In A General Hospital In Peru

Introducción: La biopsia renal es uno de los exámenes esenciales para la caracterización de la enfermedad renal crónica (ERC). Objetivo: Determinar las glomerulonefritis primarias y secundarias más frecuentes, las complicaciones de la biopsia renal y el número de pacientes en hemodiálisis al ser sometidos a biopsia renal. Métodos: Estudio observacional, descriptivo, de serie de casos, retrospectivo y transversal, realizado en el hospital nacional E. Rebagliati Matins-Perú. Se revisaron las historias clínicas de pacientes mayores de 15 años de edad sometidos a biopsia renal entre 2008-2016. Los datos fueron procesados en Stata 16.1 Resultados: De 2278 historias clínicas, correspondieron a mujeres 1234 y a hombres 1044. Las glomerulonefritis primarias y secundarias más frecuentes fueron glomeruloesclerosis focal y segmentaria (GEFyS) 683 (29,98%) y lupus eritematoso sistémico (LES) 434 (19,04%) respectivamente. De 1644 pacientes biopsiados, 36 (2,19%) y 241 (14,66%), tuvieron complicaciones mayores y menores respectivamente. Las complicaciones mayores fueron más frecuentes cuando el procedimiento lo realizó radiología con guía ecográfica en relación al realizado por el nefrólogo sin guía ecográfica (p = 0,03694). En 1324 pacientes, 329 fueron sometidos a biopsia renal estando en hemodiálisis; de ellos 43 (13,07%) lograron salir de esta terapia y 144 (51,99%) tuvieron complicaciones mayores o menores. Conclusiones: La GEFyS y LES fueron las glomerulonefritis primarias y secundarias más frecuentes, respectivamente. En 1644 pacientes las complicaciones mayores y menores fueron 36 (2,19%) y 241 (14,66%) respectivamente. En 1324 pacientes, 329 (24,8%) fueron biopsiados estando en hemodiálisis y de ellos 144 (51,99%) tuvieron complicaciones mayores o menores.

Introduction: Kidney biopsy is one of the essential tests for the characterization of chronic kidney disease (CKD). Objective: To determine the most frequent primary and secondary glomerulonephritis, complications of renal biopsy and the number of patients on hemodialysis when undergoing renal biopsy. Methods: Observational, descriptive, case series, retrospective and cross-sectional study, carried out at the E. Rebagliati Matins-Peru national hospital. The medical records of patients older than 15 years of age who underwent kidney biopsy between 2008-2016 were reviewed. The data were processed in Stata 16.1 Results: Of 2278 medical records, they corresponded to 1234 women and 1044 men. The most frequent primary and secondary glomerulonephritis were focal and segmental glomerulosclerosis (FSGS) 683 (29.98%) and systemic lupus erythematosus (SLE). ) 434 (19.04%) respectively. Of 1644 biopsied patients, 36 (2.19%) and 241 (14.66%) had major and minor complications respectively. Major complications were more frequent when the procedure was performed by radiology with ultrasound guidance compared to that performed by the nephrologist without ultrasound guidance (p = 0.03694). In 1,324 patients, 329 underwent kidney biopsy while on hemodialysis; of them 43 (13.07%) managed to get out of this therapy and 144 (51.99%) had major or minor complications. Conclusions: GEFyS and SLE were the most frequent primary and secondary glomerulonephritis, respectively. In 1644 patients the major and minor complications were 36 (2.19%) and 241 (14.66%) respectively. In 1,324 patients, 329 (24.8%) were biopsied while on hemodialysis and 144 (51.99%) of them had major or minor complications.

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients. The European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients. The task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode. Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

Etnobotánica médica urbana y periurbana de la ciudad de Córdoba (Argentina) / Urban and peri-urban medical ethnobotany in the city of Córdoba (Argentina)

Following is submitted an ethnobotanic study on knowledge and practices on usage, role and meaning of plants and relatives used by practitioners of non-official medicine in urban and peri-urban places of the city of Córdoba, Argentina. In this study area, it can be observed a cultural structure of knowledge as well as local and foreign practices, which are typical of modern cultures. Diverse social actors perform as cultural connectors between urban and rural scenarios, which match traditional components with those of biomedicine as well as those that belong to a large chain of medical herbs marketing. Quantitative and qualitative methods were resorted to, through classical ethnobotanic techniques. An amount of 768 therapeutical usages were registered which correspond to 262 native and foreign medical taxons. These taxons belong to 95 family plants marketed within urban and peri-urban areas. It is also remarkable an urban pharmacopeia highly diverse as regards species and usages with a top level of exotic species (60%) as well as complementary alternative and global medicines in theses contexts.

Se presenta un estudio etnobotánico de los conocimientos y prácticas referidos al uso, rol y significado de los vegetales usados por practicantes de la medicina no oficial en poblaciones urbanas y periurbanas de la ciudad de Córdoba, Argentina. En este ámbito de estudio, se conforma un complejo cultural de saberes y prácticas locales y foráneas, típicas de culturas modernas. Se destaca el protagonismo de diversos actores sociales los que actúan como conectores culturales entre escenarios urbanos y rurales, los que combinan elementos tradicionales con los de la biomedicina, como así también los que forman parte de una larga cadena de comercialización de hierbas medicinales. Se recurrió a métodos cualitativos y cuantitativos mediante técnicas clásicas etnobotánicas. Se documentaron un total de 768 usos terapéuticos correspondientes a 262 taxones medicinales de estatus autóctonos y exóticos que pertenecen a 95 familias de plantas comercializadas en el ámbito urbano y periurbano. Se advierte una farmacopea urbana altamente diversificada en especies y aplicaciones con un predominio de especies exóticas (60%) como así también la presencia influyente de las medicinas alternativas complementarias y de medicinas globales en estos contextos.

Cribado auditivo neonatal en piel con piel versus en la cuna / Hearing screening for newborns: skin-on-skin vs. in cradle

OBJETIVO: determinar si el cribado auditivo neonatal realizado en piel con piel con la madre es mejor tolerado (despertar o no durante la prueba, presencia o ausencia de llanto durante la prueba) que cuando se realiza en la cuna, e identificar las intervenciones necesarias para calmar al recién nacido (RN) que presenta llanto. MÉTODO: estudio cuasiexperimental con RN entre 32 y 41 semanas de edad gestacional realizado en la Unidad de Neonatología del Hospital Universitario Infanta Cristina (Parla, Madrid). Grupo intervención: piel con piel; grupo control: cuna. VARIABLES: tolerancia a la prueba a través del llanto y despertar; tipo de consuelo requerido para calmarse si se presenta llanto (contención, succión, dilución de sacarosa más succión y varias de forma simultánea). Se llevó a cabo un análisis bivariante con uso de a través de t de Student, U de Mann-Whitney y coeficiente de correlación de Pearson. RESULTADOS: se incluyeron 79 cribados auditivos, 39 en el grupo control y 40 en el grupo intervención. Se observó que los pacientes en cuna se despertaban con más frecuencia (p= 0,063) y lloraban más (p= 0,050). En un 80%, el consuelo requerido por los RN del grupo intervención fue contención; en el grupo control fueron necesarias varias intervenciones. CONCLUSIONES: los recién nacidos manifiestan mejor tolerancia a la prueba, despertando y llorando con menor frecuencia y precisando menos intervenciones para tranquilizarse. Se recomienda realizar el cribado auditivo neonatal en contacto piel con piel con la madre

OBJECTIVE: to determine if hearing screening conducted in newborns skin-on-skin with their mothers is better tolerated (waking up or nor during the test, presence or lack of crying during the test) than when conducted in cradle, and to identify those interventions necessary to calm down the newborn (NB) who starts to cry. METHOD: a quasi-experimental study with NB with a gestational age of 32-to-41 weeks, conducted at the Neonatology Unit of the Hospital Universitario Infanta Cristina (Parla), Madrid. Intervention arm: skin-on-skin; Control arm: in cradle. VARIABLES: Tolerability to the test through crying and waking up; type of consolation required to calm them down if crying (containment hold, suction, saccharose dilution plus suction, and various simultaneously). Bivariate analysis was conducted, through Student's t test, Mann-Whitney U Test, and Pearson Correlation Coefficient. RESULTS: the study included 79 hearing screenings: 39 in the Control arm and 40 in the Intervention arm. It was observed that patients in cradle woke up more frequently (p = 0.063) and cried more (p= 0.050). The consolation required by 80% of the NB in the Intervention arm was containment hold; in the Control arm, various interventions were required. CONCLUSION: newborns show better tolerability to the test, waking up and crying with lower frequency and requiring fewer interventions to calm down. It is recommended to conduct hearing screening during skin-on-skin contact with their mother

Endoscopic Treatment for Vesicoureteral Reflux in Recurrent Urinary Tract Infections in Kidney Transplant: Experience of One Center.

Vesicoureteral reflux (VUR) after renal transplantation in adult patients has been reported. In renal transplant recipients, symptomatic urinary tract infection can cause high morbidity despite improved immunosuppressive and antibiotic treatment. In our country there have been few reported cases about use of copolymer of dextranomer and hyaluronic acid (DX-HA) injection in a renal transplant. We present 3 cases of recurrent or complicated infections with evidence of high-grade VUR, which were treated with DX-HA. Only 1 case had a partial remission; however, there were no episodes of urinary tract infection in 12 months of follow-up. Suburethral injection is an endoscopic treatment modality with low morbidity in our country.

The clinical significance of pneumonia in patients with respiratory specimens harbouring multidrug-resistant Pseudomonas aeruginosa: a 5-year retrospective study following 5667 patients in four general ICUs.

Pseudomonas aeruginosa is the leading cause of pneumonia in intensive care units (ICUs), with multidrug-resistant (MDR) strains posing a serious threat. The aim of this study was to assess the clinical relevance of MDR Pseudomonas isolates in respiratory clinical specimens. A 5-year retrospective observational study in four medical-surgical ICUs from a referral hospital was carried out. Of 5667 adults admitted to the ICU, 69 had MDR-PA in respiratory samples: 31 were identified as having pneumonia (HAP/VAP): 21 ventilator-associated pneumonia (VAP) and ten hospital-acquired pneumonia (HAP). Twenty-one (67.7%) adults with MDR-PA HAP/VAP died after a median of 4 days (18 of the 21 deaths within 8 days), compared with one (2.6%) without pneumonia at day 8. In a Cox proportional regression model, MDR-PA pneumonia was an independent variable [adjusted hazard ratio (aHR) 5.92] associated with 30-day ICU mortality. Most strains (85.1%) were susceptible to amikacin and colistin. Resistance to beta-lactams (third-generation cephalosporins and piperacillin-tazobactam) ranged from 44.1% to 45.3%. Meropenem showed poor overall activity (MIC[50/90] 16/32 mg/dL), with 47.0% having a minimum inhibitory concentration (MIC) breakpoint >8 mg/L. Twenty-four (77.4%) HAP/VAP episodes received inappropriate empirical therapy. Although empirical combination therapy was associated with less inappropriate therapy than monotherapy (16.7% vs. 88.3%, p < 0.01), there was no difference in survival (30% vs. 33.3%, p = 0.8). Pneumonia was identified in one-third of adult ICU patients harbouring MDR-PA in respiratory clinical specimens. These patients have a 6-fold risk of (early) death compared to ventilator-associated tracheobronchitis (VAT) and respiratory colonisation. New antibiotics and adjuvant therapies are urgently needed to prevent and treat MDR-PA HAP/VAP.

Exposure of adolescent mice to 3,4-methylenedioxypyrovalerone increases the psychostimulant, rewarding and reinforcing effects of cocaine in adulthood.

BACKGROUND AND PURPOSE: 3,4-Methylenedioxypyrovalerone (MDPV) is a synthetic cathinone with powerful psychostimulant effects. It selectively inhibits the dopamine transporter (DAT) and is 10-50-fold more potent as a DAT blocker than cocaine, suggesting a high abuse liability. The main objective of the present study was to assess the consequences of an early (adolescence) MDPV exposure on the psychostimulant, rewarding and reinforcing effects induced by cocaine in adult mice. EXPERIMENTAL APPROACH: Twenty-one days after MDPV pretreatment (1.5 mg·kg-1 , s.c., twice daily for 7 days), adult mice were tested with cocaine, using locomotor activity, conditioned place preference and self-administration (SA) paradigms. In parallel, dopamine D2 receptor density and the expression of c-Fos and ΔFosB in the striatum were determined. KEY RESULTS: MDPV treatment enhanced the psychostimulant and conditioning effects of cocaine. Acquisition of cocaine SA was unchanged in mice pretreated with MDPV, whereas the breaking point achieved under a progressive ratio programme and reinstatement after extinction were higher in this group of mice. MDPV decreased D2 receptor density but increased ΔFosB expression three-fold. As expected, acute cocaine increased c-Fos expression, but MDPV pretreatment negatively influenced its expression. ΔFosB accumulation declined during MDPV withdrawal, although it remained elevated in adult mice when tested for cocaine effects. CONCLUSION AND IMPLICATIONS: MDPV exposure during adolescence induced long-lasting adaptive changes related to enhanced responsiveness to cocaine in the adult mice that seems to lead to a higher vulnerability to cocaine abuse. This particular behaviour correlated with increased expression of ΔFosB.

Infections in intensive care unit adult patients harboring multidrug-resistant Pseudomonas aeruginosa: implications for prevention and therapy.

The purpose of this paper was to report the burden and characteristics of infection by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical samples from intensive care unit (ICU) adults, and to identify predictors. This was a retrospective observational study at four medical-surgical ICUs. The case cohort comprised adults with documented isolation of an MDR-PA strain from a clinical specimen during ICU stay. Multivariate analysis was performed to identify predictors for MDR-PA infection. During the study period, 5667 patients were admitted to the ICU and P. aeruginosa was isolated in 504 (8.8%). MDR-PA was identified in 142 clinical samples from 104 patients (20.6%); 62 (43.6%) of these samples appeared to be true infections. One hundred and eighteen (83.1%) isolates were susceptible only to amikacin and colistin, and 13 (9.2%) were susceptible only to colistin. Overall, the MIC50 to meropenem was 16 µg/mL and the MIC90 was >32 µg/mL, with 60.4% of respiratory samples being MIC >32 µg/mL to meropenem. Independent predictors for MDR-PA infection were fever/hypothermia [odds ratio (OR) 9.09], recent antipseudomonal cephalosporin therapy (OR 6.31), vasopressors at infection onset (OR 4.40), and PIRO (predisposition, infection, response, and organ dysfunction) score >2 (OR 2.06). This study provides novel information that may be of use for the clinical management of patients harboring MDR-PA and for the control of the spread of this organism.