Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study.

OBJECTIVE: To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI). DESIGN: Observational, prospective and multicenter study (PEEP-PIC study). SETTING: Seventeen intensive care units in Spain. PATIENTS: Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018. INTERVENTIONS: Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min. MAIN VARIABLES OF INTEREST: PEEP and ICP changes. RESULTS: One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24-9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = -0.14, P = .052). ICP increment was higher in patients with lower baseline ICP. CONCLUSIONS: PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.

Black Truffle Aroma Evaluation: SPME-GC-MS vs. Sensory Experts.

Nowadays, the truffle aroma attribute is not included as a quality parameter in the current recommendation that explains the truffle quality (UNECE standard 53 FFV3) and establishes the truffle commercial categories. However, the aroma is the main reason why truffles are worldwide appreciated. Indeed, more than 30 aromatic molecules compose it, and this is the reason why the human evaluation and identification of these odorants, without previous training, is quite subjective. Analytical techniques such as gas chromatography techniques, however, can establish an aromatic profile and detect potential aromatic markers. In this study, 16 tasting experts were trained to make more objective the truffle aroma evaluation and odorants identification. For this, a comparison between solid-phase microextraction gas chromatography coupled with mass spectrometry (SPME-GC-MS) and sensory expert evaluation was carried out in six sessions during different harvesting times in the black truffle season (December, January, and February). Both techniques were able to separate truffles depending on the harvesting time. Also, a list of volatile organic compounds related to the aromatic attributes was reported. This information will help to provide a more objective T. melanosporum truffle sensory evaluation.

Black truffle aroma transfer kinetics to food matrices.

Nowadays black truffles are so highly valued that truffled products are available in supermarkets whereas fresh truffle is mainly used in the restaurants. It is known that truffle aroma can change because heat treatments, but there is no scientific evidence about what molecules are transferred, in which concentration, and how much time is needed to aromatize products with truffle. In this study, four different fat-based food products (milk, sunflower oil, grapeseed oil and egg's yolk), were used to study black truffle (Tuber melanosporum) aroma transference for 14 days. Gas chromatography and olfactometry results showed different volatile organic compounds profile depending on the matrix used. After 24 h, some key truffle aromatic compounds were detected in all the food matrices. Among them, grape seed oil was the most aromatized product probably because of its odorless properties. According to our results, dimethyl disulphide, 3-methyl-1-butanol and 1-octen-3-one odorants showed the highest aromatization power.

Associated Risk Factors and Impact in Clinical Outcomes of Multiorgan Failure in Patients with TBI.

BACKGROUND: Individual extracerebral organ dysfunction is common after severe traumatic brain injury (TBI) and impacts outcomes. However, multiorgan failure (MOF) has received less attention in patients with isolated TBI. Our objective was to analyze the risk factors associated with the development of MOF and its impact in clinical outcomes in patients with TBI. METHODS: This was an observational, prospective, multicenter study using data from a nationwide registry that currently includes 52 intensive care units (ICUs) in Spain (RETRAUCI). Isolated significant TBI was defined as Abbreviated Injury Scale (AIS) ≥ 3 in the head area with no AIS ≥ 3 in any other anatomical area. Multiorgan failure was defined using the Sequential-related Organ Failure Assessment as the alteration of two or more organs with a score of ≥ 3. We analyzed the contribution of MOF to crude and adjusted mortality (age and AIS head) by using logistic regression analysis. A multiple logistic regression analysis was performed to analyze the risk factors associated with the development of MOF in patients with isolated TBI. RESULTS: A total of 9790 patients with trauma were admitted to the participating ICUs. Of them, 2964 (30.2%) had AIS head ≥ 3 and no AIS ≥ 3 in any other anatomical area, and these patients constituted the study cohort. Mean age was 54.7 (19.5) years, 76% of patients were men, and ground-level falls were the main mechanism of injury (49.1%). In-hospital mortality was 22.2%. Up to 185 patients with TBI (6.2%) developed MOF during their ICU stay. Crude and adjusted (age and AIS head) mortality was higher in patients who developed MOF (odds ratio 6.28 [95% confidence interval 4.58-8.60] and odds ratio 5.20 [95% confidence interval 3.53-7.45]), respectively. The logistic regression analysis showed that age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring were significantly associated with MOF development. CONCLUSIONS: MOF occurred in 6.2% of patients with TBI admitted to the ICU and was associated with increased mortality. MOF was associated with age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring.

Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors.

Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.

Antibiotic properties of Satureja montana L. hydrolate in bacteria and fungus of clinical interest and its impact in non-target environmental microorganisms.

The aim of this study was to analyse the microbicidal and microbiostatic activity of S. montana hydrolate L., the water-soluble fraction of the hydro-distillation process used to obtain the essential oil, on 14 Gram-positive and Gram-negative bacteria and a fungus of clinical interest. To consider whether this hydrolate is a more environmentally friendly alternative to traditional antibiotics, its effect on non-target microorganisms in the aquatic and terrestrial environment was analysed using natural soil and river microorganism communities, characterized through 16S rRNA gene sequencing. Results showed that S. montana hydrolate was especially effective (25% v/v concentration) against Pasteurella aerogenes, Streptococcus agalactiae and Acinetobacter baumannii (priority 1, WHO). It was also a microbicide for a further 7 bacterial strains and the fungus Candida albicans (50% v/v concentration). The river and soil communities exposed to the hydrolate showed a decrease in their growth, as well as a decrease in their ability to metabolize polymers and carbohydrates (soil microorganisms) and polymers, carboxylic and ketone acids (river microorganisms). Hydrolates could be an alternative to conventional antibiotics, but their impact on the environment must be taken into account.

Risk Factors Associated with Mortality in Severe Chest Trauma Patients Admitted to the ICU.

Our objective was to determine outcomes of severe chest trauma admitted to the ICU and the risk factors associated with mortality. An observational, prospective, and multicenter registry of trauma patients admitted to the participating ICUs (March 2015-December 2019) was utilized to collect the patient data that were analyzed. Severe chest trauma was defined as an Abbreviated Injury Scale (AIS) value of ≥3 in the thoracic area. Logistic regression analysis was used to evaluate the contribution of severe chest trauma to crude and adjusted ORs for mortality and to analyze the risk factors associated with mortality. Overall, 3821 patients (39%) presented severe chest trauma. The sample's characteristics were as follows: a mean age of 49.88 (19.21) years, male (77.6%), blunt trauma (93.9%), a mean ISS of 19.9 (11.6). Crude and adjusted (for age and ISS) ORs for mortality in severe chest trauma were 0.78 (0.68-0.89) and 0.43 (0.37-0.50) (p < 0.001), respectively. In-hospital mortality in the severe chest trauma patients without significant traumatic brain injury (TBI) was 5.63% and was 25.71% with associated significant TBI (p < 0.001). Age, the severity of injury (NISS and AIS-head), hemodynamic instability, prehospital intubation, acute kidney injury, and multiorgan failure were risk factors associated with mortality. The contribution of severe chest injury to the mortality of trauma patients admitted to the ICU was very low. Risk factors associated with mortality were identified.

Development of a new score for early mortality prediction in trauma ICU patients: RETRASCORE.

BACKGROUND: Severity scores are commonly used for outcome adjustment and benchmarking of trauma care provided. No specific models performed only with critically ill patients are available. Our objective was to develop a new score for early mortality prediction in trauma ICU patients. METHODS: This is a retrospective study using the Spanish Trauma ICU registry (RETRAUCI) 2015-2019. Patients were divided and analysed into the derivation (2015-2017) and validation sets (2018-2019). We used as candidate variables to be associated with mortality those available in RETRAUCI that could be collected in the first 24 h after ICU admission. Using logistic regression methodology, a simple score (RETRASCORE) was created with points assigned to each selected variable. The performance of the model was carried out according to global measures, discrimination and calibration. RESULTS: The analysis included 9465 patients: derivation set 5976 and validation set 3489. Thirty-day mortality was 12.2%. The predicted probability of 30-day mortality was determined by the following equation: 1/(1 + exp (- y)), where y = 0.598 (Age 50-65) + 1.239 (Age 66-75) + 2.198 (Age > 75) + 0.349 (PRECOAG) + 0.336 (Pre-hospital intubation) + 0.662 (High-risk mechanism) + 0.950 (unilateral mydriasis) + 3.217 (bilateral mydriasis) + 0.841 (Glasgow ≤ 8) + 0.495 (MAIS-Head) - 0.271 (MAIS-Thorax) + 1.148 (Haemodynamic failure) + 0.708 (Respiratory failure) + 0.567 (Coagulopathy) + 0.580 (Mechanical ventilation) + 0.452 (Massive haemorrhage) - 5.432. The AUROC was 0.913 (0.903-0.923) in the derivation set and 0.929 (0.918-0.940) in the validation set. CONCLUSIONS: The newly developed RETRASCORE is an early, easy-to-calculate and specific score to predict in-hospital mortality in trauma ICU patients. Although it has achieved adequate internal validation, it must be externally validated.

Recomendaciones de "hacer" y "no hacer" en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante deCOVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) / Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)

El 11 de marzo de 2020 el director general de la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el SARS-CoV-2 (COVID-19) como una pandemia. La propagación y evolución de la pandemia está poniendo a prueba los sistemas sanitarios de decenas de países y ha dado lugar a una miríada de artículos de opinión, planes de contingencia, series de casos e incipientes ensayos. Abarcar toda esta literatura es complejo. De forma breve y sintética, en la línea de las anteriores recomendaciones de los Grupos de Trabajo, la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) ha elaborado esta serie de recomendaciones básicas para la asistencia a pacientes en el contexto de la pandemia

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic

Associated risk factors and outcomes of acute kidney injury in severe trauma: Results from the Spanish trauma ICU registry (RETRAUCI).

INTRODUCTION: Acute kidney injury (AKI) constitutes a common complication after severe trauma. Our objective was to analyse the associated risk factors and outcomes of AKI in a large, multicentre sample of trauma ICU patients. MATERIALS AND METHODS: Observational, prospective and multicentre nationwide registry (RETRAUCI). We included all patients admitted to the participating ICUs from November 2013 to May 2017. We analysed the impact of AKI evaluated by the Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) definition. Comparison of groups was performed using Wilcoxon test, Chi-Square Test or Fisher's exact test as appropriate. A multiple logistic regression analysis was performed to analyse associated factors to the development of AKI. Logistic regression was used to calculate AKI-related mortality. A P value<0.05 was considered significant. RESULTS: During the study period, 5882 trauma patients were admitted. Complete data were available for 5740 patients. Among them, 871 had AKI (15.17%), distributed by RIFLE R 458 (7.98%), RIFLE I 234 (4.08%) and RIFLE F 179 (3.12%). Associated risk factors were: age (OR 3.05), haemodynamic instability (OR 2.90 to OR 8.34 depending on the severity of hypotension), coagulopathy (OR 1.82), rhabdomyolysis (OR 4.67) and AIS abdomen (OR 1.54). AKI was associated with mortality (crude OR 1.93 (1.59-2.36)), even after adjusting by potential confounders (adjusted OR 1.40 (1.13-1.73)). CONCLUSION: In our large sample of trauma ICU patients we found an incidence of AKI of 15%, which was associated with an increased mortality.

Atención al traumatismo craneoencefálico grave en España / Severe head injury in Spain

No disponible

Assessment of the Pneumatic Ischemia Technique Using the Limb Occlusion Pressure During Upper Limb Surgery.

PURPOSE: The purpose of our study was to evaluate effective ischemia and its associated complications using the limb occlusion pressure technique versus standard pneumatic ischemia technique. DESIGN: Single-centered randomized, controlled clinical trial. METHODS: One hundred sixty participants were randomized into two equal and parallel groups: (1) intervention group-LOP technique, and (2) control group-standard pneumatic ischemia technique. FINDINGS: Anesthetic incidences (need to administer analgesics for pain and/or hypnotics for anxiety) were similar in both groups. Statistically significant differences were observed for pain, hyperemia, and hospitalization, with higher values in the control group. Patients in the intervention group had, at 95% confidence, a 2.9 times greater chance of having optimal ischemia (assessed as 9 on the analog scale) than patients in the control group (odds ratio, 2.9; 95% confidence interval, 1.4 to 6.1). CONCLUSIONS: Intervention group patients had lower indexes of hyperemia, pain, and hospital stay.

Age-related injury patterns in Spanish trauma ICU patients. Results from the RETRAUCI.

BACKGROUND: Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS: We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23rd, 2012 to July 31st, 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly). Quantitative data were reported as median (Interquartile Range (IQR) 25-75) and categorical data as number and percentage. Comparison between groups of age with quantitative variables was performed using the analysis of variance (ANOVA) test. Differences between groups with categorical variables were compared using the chi-square test. A value of p<0.05 was considered significant. RESULTS: We included 2700 patients (78.9% male). Median age was 46 (31-62) years. Blunt trauma was present in 93.7% of the patients. Median RTS was 7.55 (5.97-7.84). Median ISS was 20 (13-26). High-energy trauma secondary to motor-vehicle accident with rhabdomyolysis and drugs abuse showed an inverse linear association with ageing, whilst pedestrian falls with isolated brain injury, being run-over and pre-injury antiplatelets or anticoagulant treatment increased with age (in all cases p<0.001). Multiple injuries were more common in young adults (p<0.001). Acute kidney injury prevalence was higher in elderly and very elderly patients (p<0.001). ICU Mortality increased with age in spite of similar severity scores in all groups (p<0.001). The main cause of death in all groups was intracranial hypertension. CONCLUSIONS: Different injury patterns exist in relation with ageing in trauma ICU patients. Adult patients were more likely to present high-energy trauma with significant injuries in different areas whilst elderly patients were prone to low-energy falls, complicated by antiplatelets or anticoagulants use, resulting in severe brain injury and increased mortality.

Embarazo extrauterino abdominal / Abdominal ectopic pregnancy

El embarazo extrauterino abdominal es uno de los tipos de embarazo ectópico junto con el ovárico, menos frecuentes. El diagnóstico es difícil y suele realizarse de forma tardía, lo que contribuye a aumentar la morbimortalidad materna. Presentamos el caso de un embarazo abdominal diagnosticado a las 9 semanas de amenorrea con embrión de tamaño acorde con edad gestacional, asintomática al diagnóstico, que se resolvió satisfactoriamente mediante laparotomía(AU)

Abdominal pregnancy is one of the rarest types of ectopic pregnancy. The diagnosis is difficult and is generally delayed. We report the case of an abdominal pregnancy diagnosed at 9 weeks of amenorrea, with size of embryo according to gestational age, asymptomatic at diagnosis, whichwas resolved satisfactorily by laparotomy(AU)

Melanoma maligno primario en vagina / Primary melanoma of the vagina

El melanoma primario de vagina es un tumor poco frecuente y agresivo, siendo común las metástasis en el momento de su diagnóstico. Las características citológicas de las células melanocíticas son difíciles de apreciar en una citología cérvico-vaginal. El estudio histológico debe basarse en técnicas inmunohistoquímicas (S100, MelanA y HMB45). El diagnóstico diferencial es con el carcinoma escamoso, cuando presenta un patrón epitelioide. Se ha de excluir siempre una metástasis de otra localización. Actualmente sin consenso en el tratamiento es un tumor con baja supervivencia (AU)

Primary melanoma of the vagina is an aggressive and uncommon tumor and with frequent metastases at diagnosis. It is difficult to visualize melanocytic cells in a gynecological smear. The diagnosis should be based on immunohistochemistry techniques (S100, MelanA, HMB45). The differential diagnosis is with squamous carcinoma when melanoma presents an epithelioid pattern. It is important to always exclude metastases from other locations. Currently, there is no consensus on treatment and survival is low. At this moment there's no treatment consensus for this poor survival tumour (AU)

Evaluación de un nuevo protocolo de cribado de cáncer cervical con citología convencional y test del virus del papiloma humano / Evaluation of a new cervical cancer screening protocol with pap and human papillomavirus tests

Objetivo: Comparar la eficacia del cribado de cáncer de cérvix con citología ginecológica más el test del virus del papiloma humano de alto riesgo (VPH-AR) durante el año 2011, frente al cribado solo con citología en el año 2010. Método: Atención Primaria es la responsable del cribado. Población diana del sector Barbastro: 26.936 mujeres (de 25 a 65 años). El test del VPH-AR se realiza con captura de híbridos (HC2) y cobas® 4800, entre los 30 y 65 años. Con el resultado negativo del test y la citología, nuevo control a los 5 años, según el último protocolo de la Sociedad Española de Ginecología y Obstetricia (SEGO, 2010). Resultados: Se recibieron 4.770 citologías en 2010 y 5.241 en 2011 con una cobertura entre el 36,8 y el 46,8%. Se realizaron 784 test VPH-AR en el 2010 y 3.560 en el 2011 con un 10,58% de casos positivos el primer año y 7,5% el segundo. Se diagnosticaron 18 nuevos casos de CIN2/3 en 2010 y 35 en 2011, así como 3 carcinomas invasores cada año (en 2011, 3 carcinomas microinvasores). Conclusion: La implementación del test VPH en el cribado primario de cáncer de cérvix nos ha permitido incrementar el número de lesiones preinvasivas en un 98% al año de su introducción. La implicación de Atención Primaria permite un cribado poblacional de cáncer de cérvix eficaz sin costes adicionales (AU)

Objective: To compare the effectiveness of cervical cancer screening using cytology plus the high risk human papillomavirus (HR-HPV) DNA test in 2011 versus cytology alone in 2010. Method: Screening was performed in primary care. The target population in the Barbastro sector consisted of 26,936 women (aged 25 to 65 years). The HPV test was performed with hybrid capture (HC2) and the PCR cobasW system in women between the ages of 30 and 65 years. Women with negative Pap and HPV test results underwent a 5-year recheck as per the latest protocol of Spanish Society of Obstetrics and Gynecology (SEGO, 2010). Results: A total of 4,770 Pap tests were received in 2010 and 5,241 in 2011 with coverage between 36.8 and 46.8%; 784 HPV tests were carried out in 2010 and 3,560 in 2011, with positive results in 10.58% the first year and in 7.5% the second year. Eighteen new cases of cervical intraepithelial neoplasia grades 2/3 were diagnosed in 2010 and 35 in 2011, along with 3 invasive carcinomas each year (in 2011, 3 mic invasive carcinomas). Conclusions: The implementation of HPV testing in primary screening for cervical cancer increased the number of pre-invasive lesions detected by 98% in the year of its introduction. Primary Care involvement allows screening for cervical cancer to be performed without additional costs (AU)