Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina.

Objective: To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods: Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results: Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions: To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina

[ABSTRACT]. Objective. To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods. Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results. Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions. To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

[RESUMEN]. Objetivo. Informar sobre el riesgo lesiones por accidentes de tránsito debido al consumo de alcohol, cannabis o su combinación en conductores, pasajeros y peatones. Métodos. Se estimó el riesgo mediante el método de casos cruzados. Los participantes (N = 306) fueron pacientes que habían sufrido lesiones, provenientes de una sala de urgencias en Mar del Plata (Argentina). Resultados. El consumo de alcohol (OR = 6,78, IC95% 3,75-12,25), así como el consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,73) aumentaron significativamente el riesgo de traumatismos por accidentes de tránsito. El consumo de alcohol aumentó el riesgo tanto en mujeres (OR = 8,87, IC95% 2,69-29,21) como en hombres (OR = 6,16, IC95% 3,10-12,23); así como en mayores de 30 años (OR = 6,01, IC95% 2,09-17,24) y en menores de 30 años (OR = 7,15, IC95% 3,49-14,65). Este último grupo también tuvo mayor riesgo tras un consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,75). Tanto los conductores (OR = 6,40, IC95% 3,23-12,69) como los pasajeros (OR = 13,83, IC95% 2,87-66,42) presentaron mayor riesgo después del consumo de alcohol. Conclusiones. Hasta donde sabemos, estas son las primeras estimaciones del riesgo de sufrir lesiones por accidentes de tránsito tras el consumo de alcohol y cannabis en uno de los países del Cono Sur (Argentina, Chile y Uruguay). Estos resultados ponen de relieve la urgente necesidad de aplicar y hacer cumplir medidas integrales de control del alcohol. Además, dada la tendencia mundial hacia la legalización del cannabis para consumo recreativo, nuestros resultados también podrían orientar a los responsables de las políticas para que promulguen o enmienden las leyes sobre la conducción con capacidades alteradas debido al consumo de sustancias.

[RESUMO]. Objetivo. Relatar o risco de lesões não fatais no trânsito atribuível ao álcool, à cannabis e a seu uso combinado para motoristas, passageiros e pedestres. Métodos. O risco foi estimado usando o método clínico cruzado (case-crossover). Os participantes (N=306) eram feridos atendidos em um pronto-socorro em Mar del Plata, Argentina. Resultados. O uso de álcool (OR = 6,78, IC95% 3,75; 12,25) e o uso combinado de álcool e cannabis (OR= 7,05, IC95% 1,16; 42,73) aumentaram significativamente o risco de lesões no trânsito. O uso de álcool aumentou o risco tanto em mulheres (OR = 8,87, IC95% 2,69; 29,21) quanto em homens (OR = 6,16, IC95% 3,10; 12,23); naqueles >30 anos de idade (OR = 6,01, IC95% 2,09; 17,24) e <30 anos de idade (OR = 7,15, IC95% 3,49; 14,65). Esse último grupo também apresentou um risco maior após o uso combinado de álcool e cannabis (OR = 7,05, IC95% 1,16; 42,75). Tanto motoristas (OR = 6,40, IC95% 3,23; 12,69) quanto passageiros (OR = 13,83, IC95% 2,87; 66,42) apresentaram risco maior após o consumo de álcool. Conclusões. Até onde sabemos, estas são as primeiras estimativas do risco de lesões de trânsito após o consumo de álcool e cannabis em um dos países do Cone Sul (Argentina, Chile e Uruguai). Os resultados destacam a necessidade urgente de implementar e aplicar medidas abrangentes de controle do álcool. Além disso, considerando a tendência global de legalização da cannabis para uso recreativo, nossos resultados também poderiam ajudar os formuladores de políticas a decretar ou alterar as leis sobre a condução sob efeito de substâncias psicoativas.

Superwarfarin poisoning: challenges still remain.

Superwarfarin (long-acting anticoagulant rodenticide) poisoning should be suspected in unexplained bleeding with prolonged prothrombin time, especially in the absence of another explanation. Diagnosis and treatment of this intoxication remain a challenge as the direct analysis of superwarfarin in serum is not always possible. Therefore, toxin bioavailability remains unknown and close monitoring and treatment for long periods are required to avoid serious bleeding complications. Here, we discuss a case of suspected superwarfarin poisoning to highlight the challenges in early diagnosis and the challenges we encountered in treatment management and ensuring compliance for long periods.

Multi-organ involvement and intratubular calcium phosphate deposition in the kidney biopsy: what should we investigate?

BACKGROUND: Anorexia nervosa is frequently associated with alcohol use disorder. Both of them may adversely affect almost every body system, leading to worse clinical outcomes and high mortality risk. Nonetheless, there is little evidence interrelating anorexia nervosa, alcohol use disorder, and kidney failure. CASE: We report a case of a 30-year-old male with multi-organ involvement at admission, including pancytopenia, electrolyte alterations, impaired liver function, and renal failure. The kidney biopsy revealed calcium phosphate crystalline nephropathy and IgA nephropathy. The bone marrow biopsy and aspiration showed a hypocellular bone marrow and a focal spindle cell infiltrate with atypical vascular proliferation. Nonspecific liver disease was revealed by ultrasound. Further investigation was performed, uncovering a possible masked diagnosis of anorexia nervosa and alcohol use disorder. With the restoration of adequate nutrition and the withdrawal of possible external triggers, a partial recovery was achieved. CONCLUSIONS: Anorexia nervosa and alcohol use disorder may promote tissue injury, including kidney failure, specifically calcium phosphate crystalline nephropathy and IgA nephropathy. This multi-organ involvement may lose its reversibility if anorexia nervosa and alcohol use disorder remain persistent. An early diagnosis and a successful multidisciplinary approach may prevent life-threatening complications. LEVEL OF EVIDENCE: Level V, case report.

Development and Validation of Multi-Residue Method for Drugs Analysis in Human Feces by Liquid Chromatography-Tandem Mass Spectrometry.

The use of veterinary drugs in animal production is a common practice to secure animal and human health. However, residues of administrated drugs could be present in animal food products. Levels of drugs in food of animal origin are regulated within the European Union. In recent years, residues have been detected not only in food, but also in the environmental elements such as water or soil, meaning that humans are involuntarily exposed to these substances. This article presents a multiclass method for the analysis of various therapeutic groups of pharmaceuticals in human feces. Pharmaceuticals are extracted from feces with an acid extraction solvent, and after filtration the extract was analyzed by HPLC-MS/MS. A limit of detection of 10 ng/g was achieved for 9 pharmaceuticals, with linearity over 0.99 and repeatability and reproducibility lower than 20%. The method was satisfactorily applied in 25 feces samples of individuals that had declared not to be under medical treatment for the last two months. Results indicate the presence of six different compounds at concentration between 10 and 456 ng/g. This preliminary study showed the involuntary exposure of human gut microbiota to active substances such as pharmaceuticals.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina / Riesgo de lesiones por accidentes de tránsito debido al consumo de alcohol y cannabis en pacientes de urgencias en Argentina / Risco de lesões no trânsito devido ao uso de álcool e cannabis entre pacientes atendidos em um pronto-socorro na Argentina

ABSTRACT Objective. To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods. Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results. Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions. To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

RESUMEN Objetivo. Informar sobre el riesgo lesiones por accidentes de tránsito debido al consumo de alcohol, cannabis o su combinación en conductores, pasajeros y peatones. Métodos. Se estimó el riesgo mediante el método de casos cruzados. Los participantes (N = 306) fueron pacientes que habían sufrido lesiones, provenientes de una sala de urgencias en Mar del Plata (Argentina). Resultados. El consumo de alcohol (OR = 6,78, IC95% 3,75-12,25), así como el consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,73) aumentaron significativamente el riesgo de traumatismos por accidentes de tránsito. El consumo de alcohol aumentó el riesgo tanto en mujeres (OR = 8,87, IC95% 2,69-29,21) como en hombres (OR = 6,16, IC95% 3,10-12,23); así como en mayores de 30 años (OR = 6,01, IC95% 2,09-17,24) y en menores de 30 años (OR = 7,15, IC95% 3,49-14,65). Este último grupo también tuvo mayor riesgo tras un consumo combinado de alcohol y cannabis (OR = 7,05, IC95% 1,16-42,75). Tanto los conductores (OR = 6,40, IC95% 3,23-12,69) como los pasajeros (OR = 13,83, IC95% 2,87-66,42) presentaron mayor riesgo después del consumo de alcohol. Conclusiones. Hasta donde sabemos, estas son las primeras estimaciones del riesgo de sufrir lesiones por accidentes de tránsito tras el consumo de alcohol y cannabis en uno de los países del Cono Sur (Argentina, Chile y Uruguay). Estos resultados ponen de relieve la urgente necesidad de aplicar y hacer cumplir medidas integrales de control del alcohol. Además, dada la tendencia mundial hacia la legalización del cannabis para consumo recreativo, nuestros resultados también podrían orientar a los responsables de las políticas para que promulguen o enmienden las leyes sobre la conducción con capacidades alteradas debido al consumo de sustancias.

RESUMO Objetivo. Relatar o risco de lesões não fatais no trânsito atribuível ao álcool, à cannabis e a seu uso combinado para motoristas, passageiros e pedestres. Métodos. O risco foi estimado usando o método clínico cruzado (case-crossover). Os participantes (N=306) eram feridos atendidos em um pronto-socorro em Mar del Plata, Argentina. Resultados. O uso de álcool (OR = 6,78, IC95% 3,75; 12,25) e o uso combinado de álcool e cannabis (OR= 7,05, IC95% 1,16; 42,73) aumentaram significativamente o risco de lesões no trânsito. O uso de álcool aumentou o risco tanto em mulheres (OR = 8,87, IC95% 2,69; 29,21) quanto em homens (OR = 6,16, IC95% 3,10; 12,23); naqueles >30 anos de idade (OR = 6,01, IC95% 2,09; 17,24) e <30 anos de idade (OR = 7,15, IC95% 3,49; 14,65). Esse último grupo também apresentou um risco maior após o uso combinado de álcool e cannabis (OR = 7,05, IC95% 1,16; 42,75). Tanto motoristas (OR = 6,40, IC95% 3,23; 12,69) quanto passageiros (OR = 13,83, IC95% 2,87; 66,42) apresentaram risco maior após o consumo de álcool. Conclusões. Até onde sabemos, estas são as primeiras estimativas do risco de lesões de trânsito após o consumo de álcool e cannabis em um dos países do Cone Sul (Argentina, Chile e Uruguai). Os resultados destacam a necessidade urgente de implementar e aplicar medidas abrangentes de controle do álcool. Além disso, considerando a tendência global de legalização da cannabis para uso recreativo, nossos resultados também poderiam ajudar os formuladores de políticas a decretar ou alterar as leis sobre a condução sob efeito de substâncias psicoativas.

Rapid and assured genetic engineering methods applied to Acinetobacter baylyi ADP1 genome streamlining.

One goal of synthetic biology is to improve the efficiency and predictability of living cells by removing extraneous genes from their genomes. We demonstrate improved methods for engineering the genome of the metabolically versatile and naturally transformable bacterium Acinetobacter baylyi ADP1 and apply them to a genome streamlining project. In Golden Transformation, linear DNA fragments constructed by Golden Gate Assembly are directly added to cells to create targeted deletions, edits, or additions to the chromosome. We tested the dispensability of 55 regions of the ADP1 chromosome using Golden Transformation. The 18 successful multiple-gene deletions ranged in size from 21 to 183 kb and collectively accounted for 23.4% of its genome. The success of each multiple-gene deletion attempt could only be partially predicted on the basis of an existing collection of viable ADP1 single-gene deletion strains and a new transposon insertion sequencing (Tn-Seq) dataset that we generated. We further show that ADP1's native CRISPR/Cas locus is active and can be retargeted using Golden Transformation. We reprogrammed it to create a CRISPR-Lock, which validates that a gene has been successfully removed from the chromosome and prevents it from being reacquired. These methods can be used together to implement combinatorial routes to further genome streamlining and for more rapid and assured metabolic engineering of this versatile chassis organism.

Reduced Mutation Rate and Increased Transformability of Transposon-Free Acinetobacter baylyi ADP1-ISx.

The genomes of most bacteria contain mobile DNA elements that can contribute to undesirable genetic instability in engineered cells. In particular, transposable insertion sequence (IS) elements can rapidly inactivate genes that are important for a designed function. We deleted all six copies of IS1236 from the genome of the naturally transformable bacterium Acinetobacter baylyi ADP1. The natural competence of ADP1 made it possible to rapidly repair deleterious point mutations that arose during strain construction. In the resulting ADP1-ISx strain, the rates of mutations inactivating a reporter gene were reduced by 7- to 21-fold. This reduction was higher than expected from the incidence of new IS1236 insertions found during a 300-day mutation accumulation experiment with wild-type ADP1 that was used to estimate spontaneous mutation rates in the strain. The extra improvement appears to be due in part to eliminating large deletions caused by IS1236 activity, as the point mutation rate was unchanged in ADP1-ISx. Deletion of an error-prone polymerase (dinP) and a DNA damage response regulator (umuDAb [the umuD gene of A. baylyi]) from the ADP1-ISx genome did not further reduce mutation rates. Surprisingly, ADP1-ISx exhibited increased transformability. This improvement may be due to less autolysis and aggregation of the engineered cells than of the wild type. Thus, deleting IS elements from the ADP1 genome led to a greater than expected increase in evolutionary reliability and unexpectedly enhanced other key strain properties, as has been observed for other clean-genome bacterial strains. ADP1-ISx is an improved chassis for metabolic engineering and other applications.IMPORTANCEAcinetobacter baylyi ADP1 has been proposed as a next-generation bacterial host for synthetic biology and genome engineering due to its ability to efficiently take up DNA from its environment during normal growth. We deleted transposable elements that are capable of copying themselves, inserting into other genes, and thereby inactivating them from the ADP1 genome. The resulting "clean-genome" ADP1-ISx strain exhibited larger reductions in the rates of inactivating mutations than expected from spontaneous mutation rates measured via whole-genome sequencing of lineages evolved under relaxed selection. Surprisingly, we also found that IS element activity reduces transformability and is a major cause of cell aggregation and death in wild-type ADP1 grown under normal laboratory conditions. More generally, our results demonstrate that domesticating a bacterial genome by removing mobile DNA elements that have accumulated during evolution in the wild can have unanticipated benefits.

The complete mitochondrial genome of Xiphister atropurpureus (Perciformes: Stichaeidae).

Analysis of the marine black prickleback Xiphister atropurpureus Kittlitz using 76 bp paired-end Illumina sequences resulted in the assembly of its complete mitogenome. The mitogenome is 16,518 bp in length and contains an origin of light strand replication (OL), control region, 22 tRNA, 2 rRNA, and 13 protein-coding genes. Content and organization of the X. atropurpureus mitogenome is consistent with other teleost. Phylogenetic analysis of X. atropurpureus resolves it in a clade with another member of the Stichaeidae, Chirolophis japonicus Herzenstein.

Predicting the Genetic Stability of Engineered DNA Sequences with the EFM Calculator.

Unwanted evolution can rapidly degrade the performance of genetically engineered circuits and metabolic pathways installed in living organisms. We created the Evolutionary Failure Mode (EFM) Calculator to computationally detect common sources of genetic instability in an input DNA sequence. It predicts two types of mutational hotspots: deletions mediated by homologous recombination and indels caused by replication slippage on simple sequence repeats. We tested the performance of our algorithm on genetic circuits that were previously redesigned for greater evolutionary reliability and analyzed the stability of sequences in the iGEM Registry of Standard Biological Parts. More than half of the parts in the Registry are predicted to experience >100-fold elevated mutation rates due to the inclusion of unstable sequence configurations. We anticipate that the EFM Calculator will be a useful negative design tool for avoiding volatile DNA encodings, thereby increasing the evolutionary lifetimes of synthetic biology devices.

Spectroscopic and theoretical study of 2-acetylphenyl-2-naphthoate.

Mid-, far-infrared and Raman vibrational spectra of 2-acetylphenyl-2-naphthoate have been measured at room and low temperatures. The molecule was also analyzed by means of ab initio calculations. The conformational space has been scanned using molecular dynamics and complemented with functional density calculations that optimize the geometry of the lowest energy conformers 2-acetylphenyl-2-naphthoate as obtained in the simulations. The vibrational frequencies and the (1)H and (13)C NMR chemical shifts were assigned using functional density calculations. The theoretical chemical shift values were compared with the experimental ones. The molecular electrostatic potential maps were obtained and analyzed.

Atención médica de urgencia: organización para la recepción de víctimas múltiples / Emergency care: organization for receiving many victims

La importancia de estar preparados para enfrentar situaciones de desastres cobra mayor relevancia para los servicios de urgencia y especialmente cuando el evento ocurre de forma inesperada. Debatir las acciones a desarrollar para el manejo de eventos con víctimas múltiples, principalmente en los de inicio súbito, lo que permitiría perfeccionar los planes ante situaciones de desastres. En segundo lugar, someter a la consideración de especialistas un "sistema de tarjetas de funciones" para estas situaciones, diseñado para los servicios de urgencia de las principales instituciones de salud del territorio. Desarrollo de un taller con participación de profesionales seleccionados por su experiencia en la organización y el trabajo en los servicios de urgencia. Luego de dos conferencias plenarias, el grupo se dividió en dos comisiones, la primera trabajó los aspectos de organización prehospitalaria y la segunda en la hospitalaria. Finalmente, ambos grupos se unieron para exponer sus recomendaciones. Es necesario generar encuentros similares para incrementar el intercambio entre las instituciones, los decisores y profesionales encargados del estudio y la preparación del sistema de salud ante desastres. El tema debe extenderse al proceso de capacitación tanto a pre como a posgrado; se necesita de algunos recursos para una respuesta más efectiva, en especial medios de comunicación y para la logística del escenario; el "sistema de tarjetas de funciones", aprobado por todos, sirve metodológicamente a la respuesta, primero en función de la actualización permanente del personal y segundo por constituir una versión resumida del plan de estas instituciones.

The importance of being prepared to face disasters is greater for the emergency service and particularly when unexpected events occur. To discuss the actions to be taken to face disaster events with many victims, mainly those that suddenly occur, which will allow improving plans for disasters, and also to submit a "system of function cards" to experts, which was designed for the emergency services of the main health institutions in the territory. A workshop with the involvement of selected experienced professionals in the organization and operation of emergency services was held. After two plenary sessions, the group was divided into two commissions, the first one discussed aspects of pre-hospital organization and the second one analyzed hospital care. Finally, both groups met to make their recommendations. It is necessary to promote meetings similar to this workshop in order to increase the exchange of ideas among the institutions, the decision-makers and the professionals in charge of the study and preparation of the healthcare system for disaster management. This topic should be included in the training process at both undergraduate and graduate educational levels. Some additional resources for a more effective response, particularly means of communication and scenario logistics are required. The approved "system of function cards" methodologically serves to give response, firstly in terms of the permanent staff updating and secondly, because this system is a summarized version of the disaster plans of these institutions.

Atención médica de urgencia: organización para la recepción de víctimas múltiples / Emergency care: organization for receiving many victims

La importancia de estar preparados para enfrentar situaciones de desastres cobra mayor relevancia para los servicios de urgencia y especialmente cuando el evento ocurre de forma inesperada. Debatir las acciones a desarrollar para el manejo de eventos con víctimas múltiples, principalmente en los de inicio súbito, lo que permitiría perfeccionar los planes ante situaciones de desastres. En segundo lugar, someter a la consideración de especialistas un "sistema de tarjetas de funciones" para estas situaciones, diseñado para los servicios de urgencia de las principales instituciones de salud del territorio. Desarrollo de un taller con participación de profesionales seleccionados por su experiencia en la organización y el trabajo en los servicios de urgencia. Luego de dos conferencias plenarias, el grupo se dividió en dos comisiones, la primera trabajó los aspectos de organización prehospitalaria y la segunda en la hospitalaria. Finalmente, ambos grupos se unieron para exponer sus recomendaciones. Es necesario generar encuentros similares para incrementar el intercambio entre las instituciones, los decisores y profesionales encargados del estudio y la preparación del sistema de salud ante desastres. El tema debe extenderse al proceso de capacitación tanto a pre como a posgrado; se necesita de algunos recursos para una respuesta más efectiva, en especial medios de comunicación y para la logística del escenario; el "sistema de tarjetas de funciones", aprobado por todos, sirve metodológicamente a la respuesta, primero en función de la actualización permanente del personal y segundo por constituir una versión resumida del plan de estas instituciones(AU)

The importance of being prepared to face disasters is greater for the emergency service and particularly when unexpected events occur. To discuss the actions to be taken to face disaster events with many victims, mainly those that suddenly occur, which will allow improving plans for disasters, and also to submit a "system of function cards" to experts, which was designed for the emergency services of the main health institutions in the territory. A workshop with the involvement of selected experienced professionals in the organization and operation of emergency services was held. After two plenary sessions, the group was divided into two commissions, the first one discussed aspects of pre-hospital organization and the second one analyzed hospital care. Finally, both groups met to make their recommendations. It is necessary to promote meetings similar to this workshop in order to increase the exchange of ideas among the institutions, the decision-makers and the professionals in charge of the study and preparation of the healthcare system for disaster management. This topic should be included in the training process at both undergraduate and graduate educational levels. Some additional resources for a more effective response, particularly means of communication and scenario logistics are required. The approved "system of function cards" methodologically serves to give response, firstly in terms of the permanent staff updating and secondly, because this system is a summarized version of the disaster plans of these institutions.(AU)

[Disc alterations of lumbar spine on magnetic resonance images in asymptomatic workers]. / Alteraciones discales de columna lumbar identificadas por resonancia magnética en trabajadores asintomáticos.

OBJECTIVE: to determine abnormal findings of the lumbar spine on magnetic resonance images in asymptomatic subjects. METHODS: prospective, transverse and descriptive study, in workers of the Instituto Mexicano del Seguro Social without low back pain; they were invited to be observed with magnetic resonance images of lumbar spine. A total of 105 cases was interpreted by a radiologist, who did not know the patients' clinical conditions. 107 lumbar spine alterations studies were mixed in order to not influence in the results, and they were not included in the statistic analysis. RESULTS: 55 % of the cases had discal alterations, 38 % presented bulging disk and 17 % presented protrusion. Other alterations were Schmorl's nodule, osteocondrosis, espondilolistesis, and annular tears. CONCLUSIONS: bulging disk and discal protrusion frequency have high prevalence in magnetic resonance images in healthy individuals, so its presence in symptomatic patients is not necessarily cause of low back pain.

Satisfacción en urgencias de un hospital universitario cubano / Patient satisfaction with the emergency room of a Cuban university hospital

Objetivo: Conocer la satisfacción de los pacientes atendidos en el servicio de urgencias. Método: Se aplicó un cuestionario a los pacientes mayores de 16 años entre el 2 y el 7 de diciembre de 2002, que además estuvieran capacitados para responder el cuestionario. Fueron excluidos los pacientes que ingresaron en el hospital. Se seleccionó de cada día un mismo número de pacientes entre todos los que fueron atendidos, que representaron el 11,7 por ciento del total. Por otro lado, se mantuvo una proporción fija en relación con el área en el que cada paciente fue atendido. Resultados: Se entrevistaron 137 pacientes. El tiempo promedio de espera general hasta la clasificación fue de 2,5 ñ 3 min y ninguno de los pacientes lo consideró excesivo. El tiempo hasta la atención médica fue de 7 ñ 1,5 min y el 5,9 por ciento lo consideró excesivo. El tiempo hasta las pruebas fue de 26 ñ 25 min y el 8,7 por ciento lo consideró excesivo. La puntuación más baja la obtuvo la sala de espera (9,34 ñ 1,3) y el cuarto de exploración (9,77 ñ 0,8). La calidad global fue de 9,62 ñ 1,0 puntos. El 97,1 por ciento consideró que se había resuelto su problema, mientras que el 98,5 por ciento contestó que volvería al servicio de urgencias en caso de necesitarlo. Conclusiones: Las mayores posibilidades de mejora están en el servicio de ginecología/obstetricia si se interviene para disminuir el tiempo de espera para la asistencia médica y, en general, en el tiempo de espera hasta las pruebas, que se percibió como excesivo (AU)

Valor de la vigilancia intensiva en el posoperatorio de la cirugía arterial / Value of the intensive surveillance in the arterial surgery postoperative

Se realizó un estudio retrospectivo con el objetivo de conocer el comportamiento de todos los pacientes (35) a los que se les realizó cirugía arterial directa y que requirieron de cuidados intensivos, en el período comprendido entre enero de 1995 y diciembre de 1999. Los datos se obtuvieron a partir de un formulario que contó con las siguientes variables: edad, factores de riesgo, cirugía realizada, riesgo anestésico, tiempo quirúrgico, estadía en Unidad de Cuidados Intensivos, complicaciones posoperatorias, sobrevida y calidad de vida de estos pacientes. Existió un predominio del sexo masculino de 91,4 (por ciento); el sector más afectado fue el aortoilíaco (54,3 por ciento) y la edad promedio de 60 años. Se encontró una relación directa entre sector revascularizado, tiempo quirúrgico, estadía en UCI y complicaciones posoperatorias. El estudio de la calidad de la vida al año evidencia que 8 de cada 10 pacientes revascularizados se encuentran asintomáticos(AU)

The was carried out a retrospective study with the objective of knowing the behavior of all the patients (35) to those that were carried out direct arterial surgery and that they required of intensive cares, in the period understood between January of 1995 and December of 1999. The data were obtained starting from a form that had the following variables: age, factors of risk, carried out surgery, anesthetic risk, surgical time, demurrage in Unit of Intensive Cares, complications posoperatorias, sobrevida and quality of these patients' life. A prevalence of the masculine sex of 91,4 percent existed; the affected sector was the aortoilíaco (54,3 percent) and the age 60 year-old average. He/she was a direct relationship among sector revascularizado, surgical time, demurrage in UCI and complications posoperatorias. The study of the quality of the life a year evidences that 8 of each 10 patient revascularizados are asintomáticos(AU)

Valoración de la atención de urgencias al paciente con trauma grave / Assessment of the emergency care received by the patient with severe trauma

Con el objetivo de determinar la calidad de la atención de urgencias a los pacientes que ingresaron en el Hospital Universitario Doctor Gustavo Aldereguía Limaö de Cienfuegos, con el diagnóstico de trauma grave, se realizó un estudio descriptivo correlacionar. Se incluyeron 95 pacientes admitidos en unidades de cuidados progresivos durante el período de estudio, siguiendo el protocolo general de atención al trauma vigente en el Servicio. La edad media total de los lesionados fue de 39 años, con predominio del sexo masculino. El traumatismo craneoencefálico fue el más frecuente y de mayor mortalidad. Un análisis multivariado demostró que cerca del 50 (por ciento) de los fallecimientos estuvo relacionado con la severidad de las lesiones, el tipo de trasporte utilizado y la demora en recibir los cuidados definitivos(AU)

In order to determine the quality of the emergency care received by the patients that were admitted at Doctor Gustavo Aldereguía Lima Teaching Hospital of Cienfuegos with the diagnosis of severe trauma, a correlative descriptive study was conducted. 95 patients who were admitted in progressive care units during the studied period were included, following the general protocol of trauma care that is in force at the Service. Total average age of the injured was 39. A predominance of males was observed. The cranioencephalic trauma was the most common and that with the highest mortality. A multivariate analysis showed that at about 50 percent of the deaths were connected with the severity of the injuries, the type of transportation used and the delay in receiving the definitive care(AU)

Valor de la vigilancia intensiva en el posoperatorio de la cirugía arterial / Value of the intensive surveillance in the arterial surgery postoperative

Se realizó un estudio retrospectivo con el objetivo de conocer el comportamiento de todos los pacientes (35) a los que se les realizó cirugía arterial directa y que requirieron de cuidados intensivos, en el período comprendido entre enero de 1995 y diciembre de 1999. Los datos se obtuvieron a partir de un formulario que contó con las siguientes variables: edad, factores de riesgo, cirugía realizada, riesgo anestésico, tiempo quirúrgico, estadía en Unidad de Cuidados Intensivos, complicaciones posoperatorias, sobrevida y calidad de vida de estos pacientes. Existió un predominio del sexo masculino de 91,4(por ciento); el sector más afectado fue el aortoilíaco (54,3(por ciento) y la edad promedio de 60 años. Se encontró una relación directa entre sector revascularizado, tiempo quirúrgico, estadía en UCI y complicaciones posoperatorias. El estudio de la calidad de la vida al año evidencia que 8 de cada 10 pacientes revascularizados se encuentran asintomáticos(AU)