Prevalence of Oestrus ovis in small ruminants from the eastern Iberian Peninsula. A long-term study.

Oestrus ovis is an obligate parasite that causes myiasis in domestic ruminants, being commonly found in the Mediterranean area. From 2009 to 2019 a total of 3476 heads of culling sheep and goats from the Mediterranean coast of Spain were examined for the presence of O. ovis. The total prevalence was 56.3%, significantly higher in sheep than in goats (61.2% and 43%, respectively). Differences were found in the mean annual prevalence, with the highest value being registered in 2018 (61.7%) and the lowest in 2012 (50.3%). Autumn, for sheep, and winter, for goats, were the seasons with the highest number of infested specimens. Temperature, but not rainfall, was found to be associated with prevalence (p < 0.05). Most L1 were found in the anatomic region I (septum, meatus, and ventral conchae), while L2 and L3 were mainly located in regions II (nasopharynx, ethmoid labyrinth, and dorsal conchae), and III (sinuses). The overall intensity was 12.8 larvae per head, significantly higher in sheep (13.3) than in goats (3.5). Our results confirm the high prevalence of O. ovis in sheep and goats in this geographic area over the last decade, with the trend increasing in recent years in association with higher mean temperatures.

Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes.

INTRODUCTION: Obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and foetal outcomes is controversial. PATIENTS AND METHODS: Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI)>30kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding their prior BMI and GWG. We evaluated the impact of GWG on perinatal and obstetric outcomes. RESULTS: Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as class I in 55.3% of the cases, class II in 32.0% and class III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (<5kg) in 41.8% and excessive (>9kg) in 34.2%. Birth weight was within normal range in 81.9%, 3.6% were small for gestational age (microsomia) and 14.4% were large for gestational age (macrosomia). Insufficient GWG was associated with a higher rate of microsomal offspring, excessive GWG was associated to macrosomia and adequate GWG with normal birth weight. CONCLUSION: GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated with microsomia and excessive GWG is associated with macrosomia. Women with adequate GWG according to the IOM guidelines obtained better perinatal outcomes.

Optimisation of maintenance in delivery systems for cytostatic medicines.

BACKGROUND: The real-world application of maintenance in organisations brings together a number of maintenance policies in order to achieve the desired availability, efficiency and profitability. However, the literature mostly chooses a single maintenance policy, and so the decision process is not suited to the real conditions in the company to which it is applied. Our study takes a combination of maintenance policies as alternatives, and so conforms to the actual practice of maintenance in organisations. Furthermore, it introduces the possibility of including extra spare parts, or outsourcing maintenance policies. Although the selection of maintenance policies has been applied to many kinds of business and of machine, there is almost no instance of its application to hospitals, and it has never been applied to delivery systems for cytostatic drugs. METHODS: The model uses the fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), which is recognised as being highly suitable for solving group decision-making problems in a fuzzy environment. Fuzzy set theory is also considered to be more proficient than crisp numbers for handling the ambiguity, imprecisions, data scarcity, and uncertainty inherent in decisions made by human beings. The judgements required were obtained from a decision group comprising the heads of facilities maintenance, maintenance of medical equipment, health and safety at work, environment, and programming-admission. The group also included care staff; specifically, the heads of the main clinical services, and the medical supervisors. The model includes original criteria, such as Quality of health care, which measures impact on care as a function of mean availability of each alternative. It also considers Impact on hospital management via the criteria: Working environment in the organisation and Impact on health care; the former criterion measures equality among care services in the hospital, while the latter assesses the effect on regional health cover. The model was built using real data obtained from a state hospital in Spain. The model can also be easily applied to other national and international healthcare organisations, providing weights specific to the criteria. These are produced by a decision group from each healthcare organisation and the alternatives are updated in accordance with what is considered important in each hospital. RESULTS: The results obtained from the model recommend changing the alternative that is currently in use, Corrective and Preventive Maintenance, to Corrective and Preventive Maintenance plus two spare hoods. This alternative would lead to an availability of 1 (the highest possible) in the systems for preparing personalised cytotoxic drugs, and so the quality of service is therefore very high. Additionally, it could offer services to all the users of the hospital, and also offer cover in the preparation of cytotoxic medicines to other hospitals in the catchment area. CONCLUSIONS: The results suggest the possibility that improvements to the support and logistical systems, which include maintenance, traditionally held to have no effect on quality of care, may be key to improving care quality, but also in reducing risk to patients, care and non-care staff, and the environment.

La divulgación científica en los tiempos de Twitter / Scientific dissemination in the Twitter era

No disponible

Survey of husbandry practices for bovidae in zoos: the importance of parasite management for reintroduction programmes.

Animals from zoological institutions may be used for reintroductions. These individuals are considered healthy, but they are not necessarily free of parasites, despite the minimum husbandry standards required of zoological institutions as described in the European Association of Zoos and Aquaria guidelines. In this sense, parasitism has been identified as the cause of failure, or has added difficulties, in some reintroduction programmes. Here the authors attempt to summarise the risk of parasitism to animals originating from zoological institutions by analysing a questionnaire about parasite prevalence, sampling methods, treatment and control in three ungulates in European zoos. Completed questionnaires were received from 38 institutions (58.5 per cent response rate). Most of the responding institutions (97 per cent) detected the eggs of endoparasites in faeces, but only one reported ectoparasites. Most institutions followed a similar preventive schedule, with ivermectin as the preferred prophylactic treatment for parasites, commonly administered in food every six months. The frequent use of concentrating flotation techniques as the sole method to evaluate the presence of parasite eggs in faecal samples is not recommended because it fails to detect trematode and lung nematode infections, so it would be better to use flotation techniques together with sedimentation procedures or serological and molecular tests. The results suggest that parasite control in zoological institutions can be complicated, indicating the need to implement a specific management schedule for institutions involved in reintroduction projects.

Environmental assessment in health care organizations.

The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.

Mastopatía diabética: presentación de 3 casos clínicos / Diabetic mastopathy: Report of three cases

La mastopatía diabética es una entidad benigna y poco frecuente. Se asocia a diabetes mellitus tipo i mal controlada y de larga evolución, se manifiesta clínica y radiológicamente como un nódulo mamario, no pudiendo diferenciarlo de la enfermedad oncológica por lo que el estudio histológico de la lesión es fundamental. Presentamos 3 casos clínicos en nuestra unidad y realizamos una revisión de la literatura

Diabetic mastopathy is a benign and infrequent entity. It is associated with long-term and poorly controlled diabetes mellitus type I, manifested clinically and radiologically as a breast nodule that cannot be differentiated from oncological disease. Consequently, histological study of the lesion is essential. We present 3 cases of this entity managed in our unit and provide a review of the literature

A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.

BACKGROUND: Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. METHODS: This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. RESULTS: This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. CONCLUSIONS: The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.

Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial.

CONTEXT: A comparison of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme (LMAS) versus the LMA Proseal (LMAP) in elective laparoscopic cholecystectomy. OBJECTIVES: To compare the LMAS with LMAP in terms of ventilatory efficacy, airway leak pressure (airway protection), ease-of-use and complications. DESIGN: Prospective, single-blind, randomised, controlled study. SETTING: The Hospital del Sureste and Hospital Ramon y Cajal, Madrid, between May 2009 and March 2011. The Hospital del Sureste is a secondary hospital and Hospital Ramon y Cajal is a tertiary hospital. PATIENTS: Patients undergoing elective laparoscopic cholecystectomy were studied following informed consent. Inclusion criteria were American Society of Anesthesiologists physical status I to III and age 18 or more. Exclusion criteria were BMI more than 40 kg m, symptomatic hiatus hernia or severe gastro-oesophageal reflux. INTERVENTIONS: Anaesthesiologists experienced in the use of LMAP and LMAS participated in the trial. One hundred twenty-two patients were randomly allocated to LMAS or LMAP. MAIN OUTCOME MEASURES: Our primary outcome measure was the oropharyngeal leak pressure (OLP). Secondary outcomes were the time and number of attempts for insertion, ease of insertion of the drain tube, adequacy of ventilation and the incidence of complication. Patients were interviewed postoperatively to evaluate the presence of sore throat, dysphagia or dysphonia. RESULTS: Two patients were excluded when surgery changed from laparoscopic to open. A total of 120 patients were finally included in the analysis. The mean OLP in the LMAP group was significantly higher than that in the LMAS group (30.7 ±â€Š6.2 versus 26.8 ±â€Š4.1 cmH2O;P < 0.01). This was consistent with a higher maximum tidal volume achieved with the LMAP compared to the LMAS (511 ±â€Š68 versus 475 ±â€Š55 ml; P = 0.04). The success rate of the first attempt insertion was higher for the LMAS group than the LMAP group (96.7 and 71.2%, respectively; P < 0.01). The time taken for insertion, ease of insertion of the drain tube, complications and postoperative pharyngolaryngeal adverse events were similar in both groups. CONCLUSION: The LMAP has a higher OLP and achieves a higher maximum tidal volume compared to the LMAS, in patients undergoing elective laparoscopic cholecystectomy. The success of the first attempt insertion was higher for the LMAS.

Fracturas pélvicas por insuficiencia tras radioterapia. Diagnóstico mediante TC / Pelvic insufficiency fractures following radiotherapy. CT Diagnosis

Objetivo: Determinar la utilidad de la tomografía computarizada (TC) como método de elección para establecer el diagnóstico definitivo de fracturas pélvicas por insuficiencia (FIP) frente al de enfermedad ósea metastásica en pacientes oncológicos tratados con radioterapia. Material y métodos: Valoración de las TC pélvicas de 26 pacientes oncológicos que presentaron sintomatología aguda referida como dolor lumbar. Los hallazgos de TC recogidos fueron: esclerosis, línea de fractura y masa de partes blandas. Se correlacionaron con los estudios gammagráficos y se compararon con las TC previas. Se realizó además seguimiento clinicorradiológico. Resultados: Todos los pacientes fueron diagnosticados de forma correcta de fracturas por insuficiencia pélvica mediante estudio por TC de pelvis. Los estudios por TC mostraron esclerosis en todos los casos (100 por ciento); líneas de fractura sacras en 16 (65 por ciento) casos; fracturas púbicas (30 por ciento) en ocho casos; masa de partes blandas en los cinco casos de fractura sinfisal bilateral. Se pudo establecer seguimiento en 21 pacientes, y la TC mostró: ausencia de visualización de las líneas de fractura, tendencia a la normalización con disminución progresiva de la esclerosis y pocos cambios en las fracturas de la sínfisis púbica. Conclusión: La TC es la técnica de imagen de elección para establecer el diagnóstico definitivo de FIP. Conocer esta entidad y ser capaz de diagnosticarla correctamente permite realizar el tratamiento adecuado y evitar la realización de pruebas diagnósticas y terapéuticas innecesarias, costosas y en ocasiones contraindicadas (AU)

Aspiración endobronquial de cuerpo extraño en adultos / No disponible

No disponible

Carcinomas de lengua y suelo de boca: hallazgos en TC / Carcinomas of the tongue and floor of the mouth: computed tomography findings

Objetivo: Describir los hallazgos en la TC convencional de las neoplasias de lengua y suelo de boca, enfatizando aquellos que condicionan cambios en la actuación terapéutica, con especial interés en el conocimiento de las rutas de extensión más frecuentes. Material y Métodos: Revisión retrospectiva de 62 pacientes con neoplasias de lengua y suelo de boca estudiados con TC. En 35 pacientes se realizó tratamiento quirúrgico, asociado en 21 casos a radioterapia; 24 pacientes recibieron tratamiento combinado de quimioterapia y radioterapia y tres pacientes se negaron a cualquier tratamiento. Se estudiaron las características de la lesión, sus vías de extensión y las estaciones nodales afectadas. Resultados: Todos los casos fueron carcinomas epidermoides. La distribución por localización fue: 26 neoplasias de lengua móvil, ocho de base de la lengua y 28 lesiones del suelo de la boca. Las extensiones más frecuentes fueron: línea media (N=5), espacio sublingual (N=9) y complejo geniogloso-geniohideo (N=7) en tumores de lengua móvil; línea media (N=16), espacio sublingual (N=18), complejo geniogloso-genihioideo (N=9), músculo milohioideo (N=18), mandíbula (N=8) y obstrucción glándulas submaxilares (N=14) en neoplasias de suelo de boca; y línea media (N= 2), amígdala (N=6) y pilares glosoepiglótico y faringoepiglótico (N=3) en carcinomas de base de lengua. En 22 estudios de TC (35,5 por ciento) se detectaron metástasis cervicales. Conclusión: Aunque el diagnóstico de los tumores de cavidad oral está basado en la exploración física, los estudios de imagen prequirúrgicos constituyen un pilar fundamental para establecer una correcta valoración de los mismos y optimizar su tratamiento (AU)