Thermochemical valorization of greenhouse cucumber, tomato and pepper as biofuel.

Agricultural residues adequate managing contributes to reduce CO2 emissions and easy the circular economy. In this paper, cucumber, tomato and pepper greenhouse crop residues were characterized both chemically and energetically to potential of waste as a biofuel. When compared to other herbaceous and woody biomass, the data show higher moisture, ash and chlorine contents. The gross calorific values of these residues are in the same range as the herbaceous biomass (14.92 MJ/kg), with net values of 13.71, 14.58 and 15.73 MJ/kg for cucumber, tomato and pepper, respectively. The study also included other not common elements, finding the highest values for calcium (13-25 mg/kg) and potassium (23-30 mg/kg). To date, empirical correlations have been defined to predict the CV as a function of total C content (expressed as % in dry weight) for these residues individually. The empirical correlations obtained had maximum absolute errors (MAE) of 0.11, 0.32 and 0.58 % for cucumber, tomato and pepper whereas the marginal mean bias errors (MBE) were 0.016, 0.002 and 0.004 %, respectively, which confirms the value of using this method to determinate the gross calorific value of these residues. The correlations shown provide a useful tool for developing energy production processes based on crop residues, that would appear to be an interesting source of renewable energy to produce heat.

Compensating transport trends in the Drake Passage frontal regions yield no acceleration in net transport.

Although the westerly winds that drive the Antarctic Circumpolar Current (ACC) have increased over the past several decades, the ACC response remains an open question. Here we use a 15-year time series of concurrent upper-ocean temperature, salinity, and ocean velocity with high spatial resolution across Drake Passage to analyze whether the net Drake Passage transport has accelerated in the last 15 years. We find that, although the net Drake Passage transport relative to 760 m shows insignificant acceleration, the net transport trend comprises compensating trends across the ACC frontal regions. Our results show an increase in the mesoscale eddy activity between the fronts consistent with buoyancy changes in the fronts and with an eddy saturation state. Furthermore, the increased eddy activity may play a role in redistributing momentum across the ACC frontal regions. The increase in eddy activity is expected to intensify the eddy-driven upwelling of deep warm waters around Antarctica, which has significant implications for ice-melting, sea level rise, and global climate.

Estrés post traumático en el personal sanitario de la Unidad de Emergencia de un hospital terciario en pandemia SARS COV-2 / Post traumatic stress in the health personnel of the Emergency Unit of a tertiary hospital in SARS COV-2 pandemic

Introducción: El personal sanitario de emergencia se encuentra extremadamente expuesto a situaciones estresantes. El trastorno de estrés post traumático es una patología emergente en el personal sanitario durante los últimos años y es reconocida únicamente como enfermedad mental de carácter laboral. Objetivos: Establecer la prevalencia y síntomas asociados al trastorno de estrés post traumático obtenidos del tamizaje con lista de verificación del trastorno de estrés post traumático para DSM-5 aplicado al personal sanitario de la unidad de emergencia de un hospital terciario durante la pandemia por SARS-CoV-2. Material y Métodos: Estudio retrospectivo, de cohorte observacional, transversal, unicéntrico en los (5) estamentos profesional y no profesional, entre el periodo abril 2021 a diciembre 2022. Resultados: Participaron 241 funcionarios (69.45% de esta unidad de emergencia). Donde, un 19.9% presentó síntomas de estrés post traumático, desagregados en; 36.0% auxiliar de servicio, 26.7% kinesiología, 26.1% técnico en enfermería nivel superior, 13.3% enfermería y un 9.8% médicos. La mayor sintomatología correspondió a recuerdos intrusivos, malestar psicológico intenso, comportamiento imprudente-autodestructivo e hipervigilancia. Asimismo, a mayor antigüedad laboral y los estamentos auxiliares, kinesiología incrementan la probabilidad de puntaje alto en el tamizaje (variables de riesgo), mientras que a mayor edad disminuye (variable protector). El 29.46% fue vinculado a una atención en salud mental posterior al tamizaje. Discusión y conclusión: El estudio identificó y caracterizó a un grupo representativo de la unidad de emergencia presentó síntomas de estrés post traumático durante la pandemia SARS-CoV-2. Una red de apoyo psicológico permanente podría ser una intervención efectiva de promoción en salud mental (AU)

Introduction: Emergency medical personnel are extremely exposed to stressful situations. Post-traumatic stress disorder is an emerging pathology in health personnel in recent years and is only recognized as a mental illness of an occupational nature. Objective: To establish the prevalence and symptoms associated with post-traumatic stress disorder obtained from the screening with the checklist of post-traumatic stress disorder for DSM-5 applied to health personnel from the emergency unit of a tertiary hospital during the SARS-CoV-pandemic. 2. Material and Method: Retrospective, observational, cross-sectional, single-center study in the (5) professional and non-professional levels, between the period April 2021 to December 2022. Results: 241 officials participated (69.45% of this emergency unit). Where, 19.9% presented symptoms of post-traumatic stress, broken down into 36.0% service assistant, 26.7% kinesiology, 26.1% higher level nursing technician, 13.3% nursing and 9.8% doctors. The greatest symptomatology corresponded to intrusive memories, intense psychological discomfort, reckless-self-destructive behavior and hypervigilance. Likewise, the higher the job seniority and the auxiliary levels, kinesiology increase the probability of a high score in the screening (risk variables), while at an older age it decreases (protective variable). 29.46% were linked to mental health care after the screening. Discussion: The study identified and characterized a representative group from the emergency unit who presented post-traumatic stress symptoms during the SARS-CoV-2 pandemic. A permanent psychological support network could be an effective promotion intervention in mental health. (AU)

The role of ultrasound-guided perineural injection of the tibial nerve with a sub-anesthetic dosage of lidocaine for the diagnosis of tarsal tunnel syndrome.

Background: Tarsal tunnel syndrome (TTS) involves entrapment of the tibial nerve at the medial ankle beneath the flexor retinaculum and its branches, the medial and lateral plantar nerves, as they course through the porta pedis formed by the deep fascia of the abductor hallucis muscle. TTS is likely underdiagnosed, because diagnosis is based on clinical evaluation and history of present illness. The ultrasound-guided lidocaine infiltration test (USLIT) is a simple approach that may aid in the diagnosis of TTS and predict the response to neurolysis of the tibial nerve and its branches. Traditional electrophysiological testing cannot confirm the diagnosis and only adds to other findings. Methods: We performed a prospective study of 61 patients (23 men and 38 women) with a mean age of 51 (29-78) years who were diagnosed with idiopathic TTS using the ultrasound guided near-nerve needle sensory technique (USG-NNNS). Patients subsequently underwent USLIT of the tibial nerve to assess the effect on pain reduction and neurophysiological changes. Results: USLIT led to an improvement in symptoms and nerve conduction velocity. The objective improvement in nerve conduction velocity can be used to document the pre-operative functional capacity of the nerve. USLIT may also be used as a possible quantitative indicator of whether the nerve has the potential to improve in neurophysiological terms and ultimately inform prognosis after surgical decompression. Conclusion: USLIT is a simple technique with potential predictive value that can help the clinician to confirm the diagnosis of TTS before surgical decompression.

Ultrasound-guided aponeurotomy and interphalangeal joint capsular release for treatment of Dupuytren's disease.

This study describes a new ultrasound-guided surgical technique for aponeurotomy and interphalangeal joint capsular release in patients with Dupuytren's disease and analyses the clinical outcomes. We carried out a retrospective review of 70 digits in 35 patients who underwent ultrasound-guided aponeurotomy and interphalangeal joint capsular release, with a minimum follow-up of 2 years. The primary outcome was the correction of the deformity and the QuickDASH questionnaire score after surgery and at 1 and 2 years. The secondary outcome was the presence of residual contracture immediately after surgery. The mean QuickDASH score fell from 28 before surgery to 14 after surgery. A significant decrease of -63° was observed for the global contracture, -35° the metacarpophalangeal joint contracture and -28° for the proximal interphalangeal joint contracture. Ultrasound-guided aponeurotomy and interphalangeal joint capsular and palmar plate releases are highly accurate and safe.Level of evidence: IV.

Ultrasound-Guided Near-Nerve Needle Sensory Technique for the Diagnosis of Tarsal Tunnel Syndrome.

BACKGROUND: Tarsal tunnel syndrome (TTS) is one of the most common entrapment syndromes. Although diagnosis is supported by imaging tests, it has so far been based on clinical findings. Neurophysiological tests are not effective for providing an accurate diagnosis. The objective of this study was to analyze the efficacy of the ultrasound-guided near-nerve needle sensory technique (USG-NNNS) for the diagnosis of TTS Methods: The study population comprised 40 patients referred for a neurophysiological study owing to clinical suspicion of TTS. Routine neurophysiological tests were performed and compared with the results of USG-NNNS. RESULTS: The diagnosis of TTS was achieved in 90% of cases. We found significant differences between lateral plantar sensory recordings with surface electrodes and USG-NNNS techniques for amplitude, nerve conduction velocity (NCV), and duration. As for the medial plantar sensory recordings, differences were found only for duration. No responses were obtained with surface electrode studies in 64.8% of cases. In addition, we observed normal sensory NCV with surface electrodes in 20 patients, although this decreased when the NNNS technique was used. CONCLUSIONS: This is the first report of the efficacy of the USG-NNNS technique for confirming the diagnosis of TTS.

Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique.

BACKGROUND: Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. PURPOSE: In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. METHODS: The surgical technique-either z-plasty or transverse section of the ITB-was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29-62). RESULTS: The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5-9) before surgery to 0 (0-2) after 1 year. The HSS score improved from 58 points (47-72) to 96 at 1-2 years. There were no complications other than minor hematomas nor recurrences. CONCLUSION: Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2-3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.

Ultrasound-guided release for iliotibial band syndrome: A novel ultraminimally invasive surgical procedure.

BACKGROUND: Iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners (affecting 7-14%) and in persons taking part in other sports. The aim of this study was to show how to perform a distal release of the ITB guided by ultrasound and present our initial results with this new technique. METHODS: The surgical technique - either Z-plasty or transverse section of the ITB - was first validated on 14 cadaver specimens and then applied in clinical practice. We operated on 32 patients (27 males and five females, 34 cases) from 2013 to 2018. Mean age was 40 years (25-60). The patients comprised 21 recreational middle- or long-distance runners (23 cases), five cyclists, two basketball players, two military personnel, one fireman, and one boxer. RESULTS: All patients were satisfied after 3 months and returned to their sporting activities without restrictions. The visual analog scale score for the practice of sports activities improved from 7 (6-9) before surgery to 0 (0-1) after. The average Lysholm score was 68 points before surgery and 97 (91-100) after, with five good results and 29 excellent results. No patients complained of instability or muscle weakness after 3 months. CONCLUSION: Ultrasound-guided release of the ITB is a novel minimally aggressive surgical approach that potentially enables faster recovery. It is relatively easy, quick, and painless, with a small incision, and can be performed under local anaesthesia in an outpatient setting. It does not require limb exsanguination or stitches, and complications are minimal.

Predictors of mediastinal staging and usefulness of pet in patients with stage IIIA (N2) or IIIB (N3) lung cancer.

OBJECTIVE: To analyze which factors predict mediastinal N2/N3 lymph node staging and diagnostic accuracy of PET and CT to determine it. PATIENTS AND METHODS: We analyzed data collected prospectively in a database that included patients with non-small cell lung cancer (NSCLC) who underwent EBUS-TBNA. Prior to EBUS-TBNA, CT and PET were used to define the radiographic N stage and lymph nodes with short axis ≥ 1 cm by CT or with ratio between maximum standardized uptake value (maxSUV), by PET, of lymph node and primary tumor greater than 0.56, were considered pathological. Definitive lymph node staging was established through EBUS-TBNA, mediastinoscopy or surgical lymph node dissection. RESULTS: One hundred and thirty four patients were included, in 88 of whom (65.6%), definitive lymph node staging was N2 or N3. Primary tumor of central location, lymph node size, maxSUV of lymph node and radiographic N stage by CT or PET were associated with N2/N3 in univariate analysis, but in logistic regression model it was only independently related with N stage by CT or PET. Negative predictive value and positive predictive value of CT were 0.81 and 0.74, respectively, and for PET 0.78 and 0.68. CONCLUSION: In NSCLC, in locoregional disease radiographic staging by CT or PET predict the existence of N2/N3 mediastinal disease, but negative and positive predictive values of both imaging techniques are not adequate, so EBUS-TBNA samples should be taken in all lymph nodes with a diameter greater than 5 mm, regardless of PET findings.

Dataset for the estimation of a new body fat measurement method.

Due to the increasing prevalence of obesity and its negative consequences worldwide on public health, body composition analysis is a central pillar to assess the nutritional status. Scientists could use datasets to develop a new body fat measurement formula. Using bioelectrical impedance analysis, we analyzed the total body composition of 345 patients (234 men and 111 women) aged between 18 and 60 years residing in the metropolitan area of Barranquilla, Colombia. They have the potential for predictive formula analysis enhancing the cooperation among scientists. Due to the obesity pandemic, new datasets from other populations are needed to develop a body fat basic mathematical equation formula that could be used worldwide to determine the prevalence of overweight and obesity in a specific population group predisposed to develop metabolic syndrome or death, secondary to high cardiovascular risk.

Sputum Microbiome Dynamics in Chronic Obstructive Pulmonary Disease Patients during an Exacerbation Event and Post-Stabilization.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects up to 65 million people worldwide, and COPD exacerbation causes tissue damage and subsequent loss of lung function. It is a multifactorial event in which respiratory infections are involved, but little is known about its dynamics. OBJECTIVES: The objective of our study was to determine the microbiome composition during an exacerbation event and post-stabilization. METHODS: We conducted an observational analytical study of a cohort of 55 COPD patients in which 2 sputum samples (the first taken during an exacerbation event and the second during clinical post-stabilization) were submitted to 16s RNA ribosomal analysis by Illumina Miseq Next Generation Sequencing (NGS). The presence of respiratory viruses was also determined. RESULTS: Our study found a stable microbiome composition in the post-stabilization sputum samples of COPD patients, and 4 additional microbiomes in samples taken during the exacerbation, 3 of which showed a marked dysbiosis by Haemophilus, Pseudomonas, and Serratia. The fourth exacerbation microbiome had a very similar composition to post-stabilization samples, but some pathogens such as Moraxella and respiratory viruses were also found. CONCLUSIONS: Our study reveals the main protagonists involved in lung microbiome dynamics during an exacerbation event and post-stabilization in COPD patients by NGS analysis.

Proximal Ultrasound-Guided Gastrocnemius Recession: A New Ultra-Minimally Invasive Surgical Technique.

Selective proximal recession of the medial gastrocnemius head has clear advantages over other approaches and can be performed as a single or combined open procedure for many indications. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultraminimally invasive proximal gastrocnemius recession. We performed a pilot study with 16 cadavers to ensure that the technique was effective and safe; we then prospectively performed gastrocnemius recession in 12 patients (23 cases) with gastrocnemius contracture associated with other indications. We evaluated pre- and postprocedure dorsiflexion, clinical outcomes (based on the visual analog scale and American Orthopedic Foot and Ankle Society scores), and potential complications. We achieved effective release of the proximal medial gastrocnemius tendon in all cases, with no damage to other tissue. Ankle dorsiflexion increased 12° (range 6° to 18°) (p = .05) and was maintained throughout follow-up. The mean preoperative visual analog scale score was 7 (range 5 to 9), which improved to 1 (range 0 to 2) (p = .01). The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score improved from a mean of 25 (range 20 to 40) to 85 (range 80 to 100) at 6 months and 90 at 12 months (p = .01). No major complications were observed. We considered the technique to be safe and effective for ultrasound-guided ultraminimally invasive proximal-medial gastrocnemius recession using a 1-mm incision in vivo. This novel technique is an alternative to open techniques, with encouraging results and with the potential advantages of reducing pain and obviating lower limb ischemia and deep anesthesia, thus decreasing complications and contraindications and accelerating recovery, although further studies are required.

Anatomic Delineation of Tarsal Tunnel Innervation via Ultrasonography.

OBJECTIVES: High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves. METHODS: In this study, we analyzed the correlation between US mapping and real anatomy after cadaveric dissection, assessing the distribution and variability of the tibial nerve and its terminal branches. We used 12 fresh anatomic specimens of the foot and ankle, including the calf. A high-resolution US study of the tibial nerve and its branches was performed. RESULTS: The results of the US studies of the anatomic specimens were drawn as paper diagrams and in data collection tables. Both were completed twice per anatomic specimen, first using the results of the US study and second using the results from dissection of the anatomic specimens; this approach enabled us to compare the results and verify whether the US study and the dissection correlated on the topography of the tibial nerve and its terminal branches. We found almost total agreement between the US and dissection results, with no significant differences between the evaluations. CONCLUSIONS: On the basis of this work, we can conclude that high-resolution US is almost 100% effective as a tool for identifying the tibial nerve and its branches, enabling the specialist to make diagnoses or perform selective treatments on each nerve branch and even to design surgical interventions by observing the patient's anatomy before performing the dissection.

Costes de la tuberculosis en España: factores relacionados / Tuberculosis costs in Spain and related factors

Objetivo. Analizar los costes directos e indirectos derivados del diagnóstico y tratamiento de la tuberculosis (TB) y sus factores asociados. Pacientes y métodos. Estudio prospectivo de pacientes diagnosticados de TB entre septiembre de 2014 y septiembre de 2015. Se calcularon los costes directos (estancias hospitalarias, consultas, estudios diagnósticos y tratamiento), e indirectos (absentismo laboral y pérdida de productividad, estudio de contactos y medidas rehabilitadoras). Los costes se compararon atendiendo a las variables: edad, sexo, país de origen, ingreso hospitalario, pruebas diagnósticas, tratamiento, resistencia farmacológica, tratamiento directamente observado (TDO) y días de baja laboral. Se compararon proporciones mediante Chi cuadrado y las variables significativas se incluyeron en un modelo de regresión logística calculándose las odds ratio (OR) y sus correspondientes intervalos de confianza del 95% (IC). Resultados. Fueron incluidos 319 pacientes con una edad media de 56,72 ± 20,79 €. El coste medio fue de 10.262,62 ± 14.961,66 €, y aumentaba significativamente en relación con el ingreso hospitalario, el uso de la PCR, la realización de baciloscopia y cultivo, antibiograma, tomografía axial computarizada de tórax, biopsia pleural, tratamiento de más de 9 meses, TDO y baja laboral. En el análisis multivariante mantenían asociación independiente: ingreso hospitalario (OR = 96,8; IC: 29-472,3), antibiograma (OR = 4,34; IC: 1,71-12,1), tomografía axial computarizada de tórax (OR = 2,25; IC: 1,08-4,77), TDO (OR = 20,76; IC: 4,11-148) y baja laboral (OR = 26,9; IC: 8,51-122). Conclusión. La Tuberculosis acarrea un gasto sanitario significativo. Medidas dirigidas a mejorar el control de la enfermedad y disminuir los ingresos hospitalarios serían importantes para reducirlo

Objective. To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. Patients and methods. Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. Results. 319 patients were included with a mean age of 56.72 ± 20.79 years. The average cost was €10,262.62 ± 14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR = 96.8; CI 29-472), sensitivity testing (OR = 4.34; CI 1.71-12.1), chest CT (OR = 2.25; CI 1.08-4.77), DOT (OR = 20.76; CI 4.11-148) and sick leave (OR = 26,9; CI 8,51-122) showed an independent association with cost. Conclusion. Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required

Ultrasound-guided gastrocnemius recession: a new ultra-minimally invasive surgical technique.

BACKGROUND: Isolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra-minimally invasive gastrocnemius recession. METHODS: We performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion before and after the procedure, clinical outcomes with VAS and AOFAS scores, and potential complications, including neurovascular injuries. RESULTS: We achieved complete release of the gastrocnemius tendon in all cases in the cadaveric study, with no damage to the sural nerve or vessels and minimal damage to the underlying muscle fibers. Ankle dorsiflexion increased for every patient in the study (mean, 14°; standard deviation, 3°) and was maintained throughout follow-up. The mean preoperative VAS score was 7 (6-9), which improved to 0 (0-1). The AOFAS Ankle-Hindfoot Score improved from a mean of 30 (20-40) to 93 (85-100) at 6 months. No major complications were observed. All patients returned to their previous sports after 6 months. CONCLUSIONS: After cadaveric and clinical study, we considered the technique to be safe and effective to perform ultrasound-guided ultra-minimally invasive gastrocnemius recession using a 1-mm incision in vivo. This novel technique represents an alternative to open techniques, with encouraging results and with the advantages of reducing pain, obviating lower limb ischemia, deeper anaesthesia, thus decreasing complications and contraindications and accelerating recovery.

Tuberculosis Costs in Spain and Related Factors. / Costes de la tuberculosis en España: factores relacionados.

OBJECTIVE: To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. PATIENTS AND METHODS: Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. CONCLUSION: Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required.

Enfermedad pulmonar por Mycobacterium interjectum: a propósito de un caso / Mycobacterium interjectum Lung Infection: A Case Report

No disponible

Trends 2001 to 2008 in incidence and immediate postoperative outcomes for major joint replacement among Spanish adults suffering diabetes.

OBJECTIVES: To analyze the trend of incidence rates of primary total knee (TKA) and primary total hip arthroplasty (THA) due to osteoarthritis among Spanish adults suffering diabetes (type-1 and 2) from 2001 to 2008 and analyze in-hospital mortality (IHM), length of stay (LOS) and hospital charges compared with non-diabetic patients. METHODS: From the Spanish National Hospital Database, we selected 250,205 patients with TKA and 122,926 patients with THA; 12 and 9% of patients undergoing TKA and THA, respectively, were diabetes sufferers, of them, 1.6% was classified as type 1 in each procedure. RESULTS: Incidence of both procedures increased over the period, but diabetic patients had a larger increment compared with non-diabetic patients. The ratio of diabetes versus non-diabetes sufferers undergoing TKA increased from 0.10 in 2001 to 0.16 in 2008 and from 0.08 to 0.11 for THA. Unadjusted IHM was higher among type-2 diabetic adults in both procedures. IHM rate did not show a secular time trend among diabetic patients. LOS was significantly longer among patients with diabetes type-1 and 2 undergoing THP when compared with non-diabetic patients. Hospital charges were higher among diabetic versus non-diabetic patients for both procedures showing a significant increase over the period. CONCLUSIONS: Immediate postoperative outcomes for major joint replacement are worse among persons with than without diabetes, and prevalence of diabetes is increasing in patients undergoing these surgeries.

Obesidad y control del asma bronquial: un vínculo consistente / Asthma control and obesity: a solid link

Fundamento y objetivo: Parece existir una conexión epidemiológica entre asma bronquial y obesidad, pero su posible vínculo con el control de la enfermedad es controvertido. El objetivo del presente estudio es conocer si la obesidad se asocia con el control del asma. Pacientes y método: Se incluyeron pacientes ambulatorios, diagnosticados de asma bronquial, con buena adherencia terapéutica y técnica inhalatoria correcta. Se evaluó el control mediante el test de control del asma y se relacionó con: edad, sexo, volumen espiratorio forzado en el primer segundo, tabaquismo, índice de masa corporal (IMC), rinitis, trastornos ansioso-depresivos, bronquiectasias, reflujo gastroesofágico y atopia. Para el análisis estadístico se emplearon: ji al cuadrado, t de Student y regresión logística. Resultados: La muestra la constituyeron 110 pacientes, de los cuales 41 (37,3%) presentaban un IMC≥30kg/m2. El mal control se asoció en el análisis bivariado con: IMC, rinitis, trastornos ansioso-depresivos y sexo femenino. En el multivariado mantuvieron asociación: IMC (odds ratio [OR] 3,66, intervalo de confianza del 95% [IC 95%] 1,49-8,92), rinitis (OR 2,87, IC 95% 1,18-6,99) y trastorno ansioso-depresivo (OR 6,45, IC 95% 2,10-20). Conclusión: Hemos apreciado una asociación entre obesidad y control del asma, por lo que la reducción ponderal podría tener implicaciones clínicas (AU)

Background and objective: An epidemiological association between obesity and asthma has been confirmed, but its possible link to disease control is controversial. The aim of this study was to investigate if asthma control was related with obesity. Patients and methods: Asthmatics adult outpatients with good compliance on therapy and correct inhalation technique were included. An Asthma Control Test validated for Spanish population was used to measure asthma control and it was related with: age, sex, forced expiratory volume in one second, smoking, atopy, body mass index (BMI), rhinitis, anxiety and/or depression, bronchiectasis and gastroesophageal reflux. For statistical analysis chi square distribution, Student test and a logistic regression analysis were used. Results: One hundred and ten patients were included, of whom 41 (37.3%) had BMI 30 kg/m2. Poor asthma control was associated, in the bivariate analysis, with: BMI, rhinitis, anxiety-depressive disorders and female sex. In the multivariate analysis, it remained independently associated with: BMI (odds ratio[OR] 3.66, 95% confidence interval [95% CI] 1.49-8.92), rhinitis (OR 2.87, 95% CI 1.18-6.99 and anxiety depressive disorder (OR 6.45, 95% CI 2.10-20).Conclusions: We conclude that there is a link between obesity and poorly controlled asthma, hence weight loss may have major clinical implications (AU)