Caracterización epidemiológica de pacientes operados por fractura de escápula en Hospital Traumatológico de Concepción durante los años 2019-2022 / Epidemiological characteristics of patients operated for scapular fracture at Hospital Traumatologico de Concepción during the years 2019-2022

Introducción: Las fracturas de escápula tienen una baja frecuencia, se presentan mayoritariamente en población joven tras traumatismos de alta energía. Su tratamiento historicamente ha sido conservador, sin embargo, el tratamiento quirúrgico ha demostrado mejores resultados funcionales en pacientes seleccionados, siendo la indicación quirúrgica aún controversial. La literatura sobre los pacientes tratados de forma quirúrgica es escasa. Objetico general: Caracterizar a los pacientes operados por fractura de escapula en Hospital Traumatológico de Concepción durante los años 2019-2022. Materiales y métodos: Estudio descriptivo que incluye a pacientes operados por fractura de escápula en el Hospital Traumatológico de Concepción durante los años 2019 al 2022, considerando las variables sexo, edad, lateralidad, mecanismo de lesión y lesiones asociadas. Resultados: Se estudiaron 20 pacientes de los cuales 90% fueron hombres, registrándose un promedio de edad de 41 años, sin diferencias significativas en su lateralidad. Los principales mecanismos de lesión fueron accidentes de tránsito y caídas de altura, existiendo lesiones asociadas sólo en 45% de los casos. Conclusión: Las fracturas de escápula tienen alto impacto en la funcionalidad de la extremidad afectada, por lo que su tratamiento hoy en día esta evolucionando hacia uno quirúrgico en pacientes seleccionados, con el fin de obtener mejores resultados funcionales. Los pacientes operados son mayoritariamente adultos de edad media de sexo masculino, con fracturas secundarias a traumatismos de alta energía y presencia de lesiones asociadas de baja morbimortalidad.

Introduction: Scapula fractures have a low frequency. They occur mainly in the young population after high-energy trauma. Its treatment has historically been conservative; however, surgical treatment has shown better functional results in selected patients, the surgical indication being still controversial. The literature on patients treated surgically is scarce. General Objective: Characterize the patients operated on for scapular fracture at the Hospital Traumatológico de Concepción during the years 2019-2022. Materials and methods: Descriptive study that includes patients operated on for scapula fracture at the Concepción Trauma Hospital during the years 2019 to 2022, considering the variables sex, age, laterality, mechanism of injury and associated injuries. Results: Twenty patients were studied, of whom 90% were men, recording an average age of 41 years, with right scapula fracture being slightly more frequent than left. The main mechanisms of injury were traffic accidents and falls from a height, with associated injuries only in 45% of the cases. Conclusion: Scapula fractures have a high impact on the functionality of the affected limb, so their treatment today is evolving towards surgery in selected patients, in order to obtain better functional results. The patients operated on are mostly middle-aged male adults, with fractures secondary to high-energy trauma and the presence of associated lesions with low morbidity and mortality.

Family participation in the care of the critical patient: An exploratory study.

OBJECTIVES: To determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile. METHOD: A cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient. RESULTS: The level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r = -0.215; P = 0.019), the higher the rating of previous experience working with families (r = 0.304; P = 0.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r = 0.495: P < 0.001). The participants also state that the work environment of the unit, the patient's condition, the relatives' characteristics, personal judgement, and the preparedness of relatives affect their readiness. CONCLUSIONS: The results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.

Participación de la familia en el cuidado del paciente crítico: un estudio exploratorio / Family participation in the care of the critical patient: An exploratory study

Objetivos: Identificar el nivel de disposición (readiness) del equipo de salud frente a la participación familiar en el cuidado del paciente crítico adulto y su relación con las características individuales de los participantes, en una unidad de paciente crítico (UCI) médico-quirúrgica de Santiago de Chile. Método: Estudio correlacional de corte transversal que utiliza un método cuantitativo e incorpora un grupo focal para profundizar en la percepción del personal de salud respecto a la participación familiar en el cuidado del paciente crítico. Resultados: El nivel de readiness (disposición) del equipo de salud frente la participación familiar en el cuidado del paciente crítico es medio, siendo 13,81 puntos de un total de 20. A mayor nivel de disposición menor edad (r=−0,215; p=0,019), mejor calificación de la experiencia previa de trabajo con familias (r=0,304; p=0,006) y mayor percepción de comodidad frente a diferentes actividades del cuidado del paciente crítico (r=0,495; p<0,001). Los participantes afirman además que el contexto laboral de la unidad, la condición del paciente, las características de los familiares, el criterio personal y la preparación del familiar afectan su nivel de disposición. Conclusiones: Los resultados aportan al conocimiento de la disposición (readiness) del equipo de salud en un contexto donde la temática no se ha implementado. El nivel de disposición del equipo de salud es medio; se relaciona con algunas características individuales del personal de salud, así como con aspectos organizacionales y familiares, de modo que se requieren estrategias que aborden estos aspectos y así el nivel de disposición podría aumentar.(AU)

Objectives: To determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile. Method: A cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient. Results: The level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (r=−.215; P=.019), the higher the rating of previous experience working with families (r=.304; P=.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (r=.495: P<.001). The participants also state that the work environment of the unit, the patient's condition, the relatives’ characteristics, personal judgement, and the preparedness of relatives affect their readiness. Conclusions: the results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.(AU)

Electrooxidation of industrial wastewater containing 1,4-dioxane in the presence of different salts.

The treatment of 1,4-dioxane solution by electrochemical oxidation on boron-doped diamond was studied using a central composite design and the response surface methodology to investigate the use of SO4 (2-) and HCO3 (-) as supporting electrolytes considering the applied electric current, initial chemical oxygen demand (COD) value, and treatment time. Two industrial effluents containing bicarbonate alkalinity, one just carrying 1,4-dioxane (S1), and another one including 1,4-dioxane and 2-methyl-1,3-dioxolane (S2), were treated under optimized conditions and subsequently subjected to biodegradability assays with a Pseudomonas putida culture. Electrooxidation was compared with ozone oxidation (O3) and its combination with hydrogen peroxide (O3/H2O2). Regarding the experimental design, the optimal compromise for maximum COD removal at minimum energy consumption was shown at the maximum tested concentrations of SO4 (2-) and HCO3 (-) (41.6 and 32.8 mEq L(-1), respectively) and the maximum selected initial COD (750 mg L(-1)), applying a current density of 11.9 mA cm(-2) for 3.8 h. Up to 98 % of the COD was removed in the electrooxidation treatment of S1 effluent using 114 kWh per kg of removed COD and about 91 % of the COD from S2 wastewater applying 49 kWh per kg of removed COD. The optimal biodegradability enhancement was achieved after 1 h of electrooxidation treatment. In comparison with O3 and O3/H2O2 alternatives, electrochemical oxidation achieved the fastest degradation rate per oxidant consumption unit, and it also resulted to be the most economical treatment in terms of energy consumption and price per unit of removed COD.

Photocatalytic degradation of contaminants of concern with composite NF-TiO2 films under visible and solar light.

This study reports the synthesis and characterization of composite nitrogen and fluorine co-doped titanium dioxide (NF-TiO(2)) for the removal of contaminants of concern in wastewater under visible and solar light. Monodisperse anatase TiO(2) nanoparticles of different sizes and Evonik P25 were assembled to immobilized NF-TiO(2) by direct incorporation into the sol-gel or by the layer-by-layer technique. The composite films were characterized with X-ray diffraction, high-resolution transmission electron microscopy, environmental scanning electron microscopy, and porosimetry analysis. The photocatalytic degradation of atrazine, carbamazepine, and caffeine was evaluated in a synthetic water solution and in an effluent from a hybrid biological concentrator reactor (BCR). Minor aggregation and improved distribution of monodisperse titania particles was obtained with NF-TiO(2)-monodisperse (10 and 50 nm) from the layer-by-layer technique than with NF-TiO(2) +monodisperse TiO(2) (300 nm) directly incorporated into the sol. The photocatalysts synthesized with the layer-by-layer method achieved significantly higher degradation rates in contrast with NF-TiO(2)-monodisperse titania (300 nm) and slightly faster values when compared with NF-TiO(2)-P25. Using NF-TiO(2) layer-by-layer with monodisperse TiO(2) (50 nm) under solar light irradiation, the respective degradation rates in synthetic water and BCR effluent were 14.6 and 9.5 × 10(-3) min(-1) for caffeine, 12.5 and 9.0 × 10(-3) min(-1) for carbamazepine, and 10.9 and 5.8 × 10(-3) min(-1) for atrazine. These results suggest that the layer-by-layer technique is a promising method for the synthesis of composite TiO(2)-based films compared to the direct addition of nanoparticles into the sol.

Reciprocal sympatho-sensory control: functional role of nucleotides and calcitonin gene-related peptide in a peripheral neuroeffector junction.

The rat vas deferens has scattered sensory afferens plus a dense network of sympathetic motor efferens; these fibers are not known to interact functionally. We ascertained whether sensory fibers modulate the release of sympathetic transmitters through the release of calcitonin gene-related peptide (CGRP) and reciprocally assessed whether sympathetic transmitters modulate the overflow of ir-CGRP from sensory fibers. The tissue overflow of electrically evoked sympathetic co-transmitters (ATP/metabolites, noradrenaline (NA), and immunoreactive neuropeptide tyrosine (ir-NPY)) and the motor responses elicited were quantified following either exogenous CGRP or capsaicin application to elicit peptide release. Conversely, the outflow of ir-CGRP was examined in the presence of sympathetic transmitters. Exogenous CGRP reduced in a concentration-dependent manner the electrically evoked outflow of ATP/metabolites, NA, and ir-NPY with EC(50) values of 1.3, 0.18, and 1.9 nM, respectively. CGRP also reduced the basal NA overflow. The CGRP-evoked modulation was blocked by CGRP8-37 or H-89. Release of endogenous CGRP by capsaicin significantly reduced the basal overflow of NA, ir-NPY, and the electrically evoked sympathetic transmitter release. ADP, 2-methylthioadenosine-5'-O-diphosphate (2-MeSADP), or UTP decreased the electrically evoked ir-CGRP overflow, whereas clonidine, α,ß-methyleneadenosine 5'-triphosphate (α,ß-mATP), or adenosine (ADO) were inactive. CGRP acting postjunctionally also reduced the motor responses elicited by exogenous NA, ATP, or electrically evoked contractions. We conclude that CGRP exerts a presynaptic modulator role on sympathetic nerve endings and reciprocally ATP or related nucleotides influence the release of ir-CGRP from sensory fibers, highlighting a dynamic sympatho-sensory control between sensory fibers and sympathetic nerve ending. Postjunctional CGRP receptors further contribute to reduce the tissue sympathetic motor tone implying a pre and postjunctional role of CGRP as a sympathetic tone modulator.

Replacement of fresh water use by final effluent recovery in a highly optimized 100% recovered paper mill.

A further closure of the water circuit in paper mills with a relative high optimization of their water network is limited by the increase of contamination in the water and runnability problems of the paper machine. Therefore, new strategies for saving water must be focussed on the treatment of final effluents of the paper mill, aiming to obtain high quality water that may replace fresh water use in some applications. An appropriate treatment train performed at pilot scale, consisting on a previous clarification stage followed by anaerobic and aerobic treatments, ultrafiltration, and reverse osmosis, made possible producing the highest water quality from the final effluent of the mill. Anaerobic pre-treatment showed very good performance assisting the aerobic stage on removing organics and sulphates, besides it produced enough biogas for being considered as cost-effective. Permeate recovery depended on the silica content of the paper mill effluent, and it was limited to a 50-60%. The reject of the membranes fully met the legislation requirements imposed to effluents arriving to municipal wastewater treatment plants.

Efecto antifúngico de quitosán de alto peso molecular en cepas de Candida sp aisladas de muestras clínicas / Antifungal effect of high molecular weight chitosan on Candida spp isolated from clinical samples

Chitosan is a D-glucosamine polysaccharide derived from chitin that displays an antimicrobial activity against bacteria and fungi. Objective: to evaluate the antifungal effect of high molecular weight chitosan (HMWC) in clinical strains of Candida spp. Methodology: the susceptibility of forty strains of Candida spp. to HMWC was studied (16 C albicans, 11 C glabrata, 5 C. tropicalis, 5 C krusei, 2 C parapsilosis and 2 C.famatd) by broth microdilution at pH 7.0 and pH 4.0. Results: of 40 strains, only 2 were inhibited at pH 7.0 and corresponded to ATCC control strains (C. krusei 6258 and C parapsilosis 22019). On the other hand, 37/40 strains (92.5 percent) were inhibited by concentrations lower than 1.25 mg/mL of HMWC at pH 4.0. Conclusion: these results show that HMWC, presents activity against clinical Candida spp. strains, including C glabrata, and that this activity is present at acid pH (4.0). This compound could potentially be used in vulvovaginal candidiasis since it occurs at pH 4.0-4.5.

Distribución y susceptibilidad a fluconazol de levaduras del género Candida aisladas en pacientes hospitalizados y ambulatorios / Species distribution and fluconazole susceptibility of yeasts of genus Candida isolated from hospitalized and ambulatory patients

Most surveillance studies have included invasive candidiasis from hospitalized patients. However, no national study has evaluated the species distribution and susceptibility to fluconazole of Candida species isolated from hospitalized and ambulatory patients. Atotal of 166 strains were collected consecutively during a 6 month period. Strains were isolated from vaginal fluid (73.5 percent), uriñe (7.8 percent), lower respiratory tract samples (7.8 percent), blood cultures (4.2 percent), sterile fluids (2.4 percent) and wounds (1.8 percent). Most of the isolates were obtained from ambulatory patients (71.1 percent). The species found were Candida albicans (78.9 percent), C glabrata (8.4 percent), C. tropicalis (6.0 percento), C.famata (1.8 percent), C krusei (1.8 percent), C parapsilosis (1.8 percent) and C. sake (1.2 percent). Fluconazole susceptibility was: 92.3 percento for C. albicans, 85.7 percent for C glabrata (most strains being dose-dependent susceptible), 100 percent) for C parapsilosis and 80 percent) for C tropicalis. Only susceptible strains were isolated from hospitalized children, whereas more resistant strains were isolated from ambulatory adults, mainly from vaginal fluid. In order to identify probable reservoirs of less susceptible strains such as C. glabrata, it would be necessary to include ambulatory isolates in future surveillance studies.

La mayoría de los estudios de vigilancia de levaduras del género Candida se realizan en candidiasis invasora en pacientes hospitalizados; sin embargo, no existen estudios que evalúen simultáneamente la distribución global de especies y susceptibilidad a fluconazol de cepas de Candida aisladas de pacientes hospitalizados y ambulatorios. Se analizaron 166 cepas de Candida, recolectadas consecutivamente en un período de 6 meses, las cuales fueron aisladas de flujo vaginal (73,5 por ciento), orina (7,8 por ciento), muestras respiratorias bajas (7,8 por ciento), hemocultivos (4,2 por ciento), líquidos estériles (2,4 por ciento) y heridas (1,8 por ciento). Un 71,1 por ciento provenía de pacientes ambulatorios. La especies aisladas fueron Candida albicans (78,9 por ciento), C glabrata (8,4 por ciento), C tropicalis (6,0 por ciento), Cfamata (1,8 por ciento), C. krusei (1,8 por ciento), C parapsilosis (1,8 por ciento) y C. sake (1,2 por ciento). Los porcentajes de sensibilidad a fluconazol fueron: 92,3 por cientoo para C. albicans, 85,7 por cientoo para C glabrata (siendo la mayoría sensible dosis dependiente), 100 por ciento) para C parapsilosis y 80 por cientoo para C tropicalis. En los niños, todos hospitalizados, se aislaron sólo cepas sensibles, mientras que en adultos ambulatorios se aislaron más cepas resistentes, fundamentalmente de flujo vaginal. Considerar cepas ambulatorias en futuros estudios de vigilancia permitirían dar cuenta de probables reservónos de cepas más resistentes, como C. glabrata.