[Bilateral central femoral dislocation after seizure. Antiprotrusive ring and dual mobility cup as a therapeutic option. Apropos of a case]. / Luxación bilateral central femoral tras crisis convulsiva. Anillo antiprotrusivo y cotilo de doble movilidad como opción terapéutica. A propósito de un caso.

INTRODUCTION: seizures can trigger fractures and dislocations. Injuries depend on the severity, duration and type of seizure. We present a case report of a male patient who presented with a bilateral central dislocation fracture of the hip following an episode of seizure. A case rarely described in the literature with complex and unusual management. CASE REPORT: a 77-year-old man with a history of moderate cognitive impairment suffered a bilateral central dislocation of the hip in the context of a generalized epileptic seizure. Clinically on arrival at the emergency department, the patient presented shortening of the right lower extremity compared to the contralateral, external rotation and joint locking on log roll test in both extremities. An imaging study and clinical optimization were performed prior to surgery. It was performed in two stages. First the left hip on the 8th day of admission, and the right hip on the 15th. In both surgeries the same procedure was performed, with implantation of an antiprotrusive ring and a double mobility cup prosthesis with an uncemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. At 24-month follow-up, the patient performed full weight bearing with a Harris hip score (HHS) of 77 on the right hip and 79 on the left; 12 points on the WOMAC scale. No postoperative complications have occurred so far. CONCLUSIONS: these injuries are uncommon in our daily practice, where multiple options are available to address them. In our patient, the use of arthroplasty and antiprotrusive rings offers advantages over fracture synthesis techniques, such as early mobilization with moderate functional results and few postoperative complications.

INTRODUCCIÓN: las crisis convulsivas pueden desencadenar fracturas y luxaciones. Las lesiones dependen de la severidad, duración y el tipo de crisis. Presentamos un caso clínico de un varón que presentó una fractura luxación central bilateral de cadera tras episodio de crisis convulsiva. Un caso pocas veces descrito en la literatura con un manejo complejo y poco habitual. CASO CLÍNICO: paciente de 77 años con antecedentes de deterioro cognitivo moderado que sufrió una luxación bilateral central de cadera en contexto de una crisis convulsiva generalizada. Clínicamente, a su llegada a urgencias, el paciente presentaba un acortamiento de la extremidad inferior derecha en comparación con la contralateral, rotación externa y bloqueo articular a la realización del log roll test en ambas extremidades. Se realizó estudio de imagen y optimización clínica previo a cirugía. Se realizó en dos tiempos: primero la cadera izquierda al octavo día de ingreso y la cadera derecha al decimoquinto. En ambas cirugías se realizó el mismo procedimiento mediante implantación de anillo antiprotrusivo y prótesis con cotilo de doble movilidad con vástago femoral no cementado. En el postoperatorio inmediato, el paciente no presentó ninguna complicación asociada a la cirugía. En el seguimiento a los 12 meses, el paciente realiza carga completa con un Harris hip score (HHS) de 77 cadera derecha y 79 en la izquierda; 12 puntos en la escala WOMAC. No ha presentado complicaciones postoperatorias hasta el momento. CONCLUSIONES: estas lesiones son poco comunes en nuestra práctica diaria, donde disponemos de múltiples opciones para abordarlas. En nuestro paciente, el empleo de la artroplastía y de anillos antiprotrusivos nos ofrecen ventajas respecto a las técnicas de síntesis de la fractura, como una movilización precoz y evitar desarrollo prematuro de una artrosis postraumática, con resultados buenos, funcionales y pocas complicaciones postoperatorias.

[Evolution of blood loss in total knee prosthesis with blood recovery system vs conventional drainage]. / Evolución de la pérdida sanguínea en la prótesis total de rodilla con recuperador de sangre vs drenaje convencional.

INTRODUCTION: knee prosthetic surgery can be associated with significant blood loss that can account for up to 20% of blood volume. The objective of our study is to analyze blood loss (BL) after total knee replacement (TKR), with the use of a blood recovery system vs a normal drain. MATERIAL AND METHODS: prospective, comparative, and observational study of two groups of 30 patients who underwent TKR, one control (CG) and another study group with a recovery system (RG). We analyzed PS, hemoglobin (Hb), hematocrit (Htc), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) at 3-, 24-, 48-, 72- and 96-hours post-surgery, the need for transfusion, and the percentage of discharges in 72 hours and complications. RESULTS: the highest percentage of change in Htc and Hb occurred in the first 3 hours post-surgery and recovery began at 72 hours in the RG (p = 0.02) and at 96 hours in the CG (p = 0.04). The decrease in Hb and Htc began his recovery at 72 hours in the RG and at 96 hours in the CG. The TAS, TAD and FC began their recovery at 72 hours in both groups. The decrease in SBP was greater in the CG at 3 hours (p = 0.02), 24 hours (p = 0.02) and 48 hours (p = 0.01) post-surgery. Six patients were transfused in RG and 10 in CG (p = 0.22). 20% and 74% of the patients were discharged at 72 hours in the CG and RG, respectively. CONCLUSION: the greatest BL occurs in the first 3 hours post-surgery and recovery begins at 72-96 hours. Recovery blood system decreases BL during the first 3 hours, enhance the recuperation of Hb and SBP, decreases the need for transfusion and favors early discharge.

INTRODUCCIÓN: la cirugía protésica total de rodilla (PTR) se puede asociar a pérdidas sanguíneas (PS) significativas. El objetivo es analizar la evolución de la PS tras PTR con recuperador sanguíneo vs drenaje convencional. MATERIAL Y MÉTODOS: estudio prospectivo de dos grupos de 30 pacientes intervenidos de PTR, uno control (GC) y otro estudio con recuperador (GR). Se analizó la PS, hematocrito (Hcto), hemoglobina (Hb), tensión arterial sistólica (TAS) y diastólica (TAD) y frecuencia cardíaca (FC) a las tres, 24, 48, 72 y 96 horas postquirúrgicas, la necesidad de transfusión, el porcentaje de altas en 72 horas y las complicaciones. RESULTADOS: la mayor PS y porcentaje de cambio de Hcto y Hb se produjo a las tres horas postquirúrgicas e inició su recuperación a las 72 horas en el GR (Hcto, p = 0.02) (Hb, p = 0.04) y a las 96 horas en el GC. La TAS, TAD y FC empezó su recuperación a las 72 horas en ambos grupos. El descenso de TAS fue mayor en el GC a las tres horas (p = 0.02), 24 horas (p = 0.02) y 48 horas (p = 0.01) postquirúrgicas. Veinte y 33% de los pacientes fueron transfundidos, además 20 y 74% fueron dados de alta a las 72 horas en el GC y GR, respectivamente. CONCLUSIÓN: la mayor PS y porcentaje de cambio de Hcto y Hb se produce a las tres horas postquirúrgicas y empieza su recuperación a las 72-96 horas. El recuperador favorece la recuperación del Hcto, Hb y TAS, disminuye la necesidad de transfusión y favorece el alta precoz.

Agronomical and Physiological Behavior of Spanish Hazelnut Selection "Negret-N9" Grafted on Non-suckering Rootstocks.

"Negret" is the most widely planted hazelnut cultivar in Northeastern Spain, where it is highly appreciated by the local kernel marked for its favorable nut traits. Its main disadvantages are the high suckers emission, causing large maintenance costs every year, and its medium-to-low vigor and susceptibility to iron chlorosis. In 2000, a trial to select new vigorous and non-suckering rootstocks for hazelnut was established at IRTA Mas Bové (Spain). The "Negret N-9" selection was grafted onto four clonal rootstocks ("Dundee" and "Newberg" two selections of open-pollinated Corylus colurna seedlings, the low suckering cultivar "Tonda Bianca" and the local selection "IRTA MB-69") and compared to the self-rooted "Negret N-9" as a control. The trial was designed as a randomized complete block with 10 replications and one tree per plot (10 trees per treatment). Plant vigor, suckers emission, yield, and nut and kernel traits have been evaluated over 10 years (2003-2012). During the 2006 to 2010 growing seasons, the qualitative traits of kernels, such as kernel skin color, oil content, and fatty acid profiles, were added to the characterization. Physiological data, such as steam water potential, stomatal conductance, and leaf chlorophyll content, were also evaluated during the 2015 growing season. The results showed that clonal rootstocks had a strong influence on vigor and yield of "Negret N-9." The "Dundee," "Newberg," and "IRTA MB-69" rootstocks showed the highest vegetative growth and the lower suckers emission. The yield was highest in trees grafted on "Dundee" rootstock. In terms of the qualitative traits of kernel which are important to the hazelnut industry, rootstocks increased the oil stability and induced a brown light color in the kernel pellicle versus the brown dark color observed in nuts collected from self-rooted "Negret N-9." The fatty acids profile was also influenced by the grafting combination. Finally, physiological traits indicated a higher overall performances for "Dundee" rootstock, which was generally found to be the best rootstock for "Negret N-9" in the experimental environment.

Arthrotomy debridement of arthrostic septic arthritis of the knee is more effective than arthroscopic debridement and delays the need for prosthesis despite progression. / El desbridamiento por artrotomía de la artritis séptica de rodilla artrósica es más eficaz que el artroscópico y retrasa la necesidad de prótesis a pesar de la progresión de la artrosis.

BACKGROUND AND OBJECTIVE: 40%-50% of this septic arthritis occurs in the knee, despite rapid medical surgical treatment, 24%-50% will have a poor clinical outcome. It is not clear which debridement technique, by arthrotomy or arthroscopy, is more effective in controlling infection, or whether or not previous osteoarthritis worsens the outcome. The objective of this study on septic arthritis of the osteoarthritic knee was to analyse which surgical debridement technique, arthroscopy or arthrotomy, is more effective, the clinical and radiographic outcomes of the patients, and how many go on to require a TKR after the infection has healed. MATERIAL AND METHODS: A retrospective study was performed in 27 patients with native septic arthritis of the knee. Eighteen were men and the mean age was 64.8 years (30-89years). Fifteen patients were debrided by arthrotomy and 12 by arthroscopy. The effectiveness of debridement in controlling infection, the radiographic progression of the osteoarthritis on the Ahlbäch scale, the need for subsequent replacement, and pain and functional status were analysed using the VAS and WOMAC scales at 52.8±11.2-month follow-up. RESULTS: The infection was controlled in 93% and 92% of the patients, 13% and 42% required 2 or more surgeries for infection control, 18% and 44.4% showed progression of arthritis in the arthrotomy and arthroscopy groups, respectively. One patient in each group required a knee replacement. The VAS score was superior in the arthrotomy group and there were no differences in WOMAC score. CONCLUSION: Debridement by arthrotomy in the emergency department by non-sub-specialist knee surgeons is more effective than arthroscopic debridement in controlling septic arthritis of the knee. Surgical debridement of septic arthritis in knees with previous osteoarthritis enabled control of the infection with no pain despite the progression of the osteoarthritis.

Validity of the KLIC and CRIME80 scores in predicting failure in late acute infection treated by debridement and implant retention. / Validez de las escalas KLIC y CRIME80 en la predicción del fracaso en la infección aguda tardía tratada mediante desbridamiento y retención de implantes.

It is very important to treat prosthetic infections correctly in order to ensure a higher success rate. Debridement with implant retention (DAIR) is widely used in acute and late infections, however patients who fail after this surgery are known to have a higher risk of failure in subsequent surgeries. Therefore, it is important to find a scale that enables us to predict the risk of DAIR failure. Hence the KLIC and CRIME80 scores for acute and late acute infections, respectively. This study analysed the validity of both scores in acute late periprosthetic knee infections. We observed that the KLIC score has no predictive value for this type of infection, but the CRIME80 score does.

Análisis de las condiciones de trabajo de los especialistas en Medicina del Trabajo en 2018 / Working conditions of Occupational Medicine Specialists in 2018

Introducción: Mediante la realización de este estudio se pretende conocer las condiciones en las que trabajan los especialistas en medicina del trabajo en España. Metodología: Desarrollo de una encuesta con 57 preguntas contestadas de manera anónima, que tratan aspectos generales de las condiciones socioeconómicas, demográficas, organizativas, formativas y del entorno psicosocial, en formato digital distribuida mediante correo electrónico entre los especialistas en medicina del trabajo a nivel nacional a través de las diferentes sociedades científicas. Resultados: Obtenidas n = 478 encuestas completas, con reparto homogéneo en relación al sexo (mujeres 51% vs. Hombre 49%) con una edad media de 50,72 años, siendo más del 45% mayor de 55 años. Remuneración media entre 45-50 mil euros bruto/año con distribución en SPA (41%) vs SPP (37%) y con contratos por cuenta ajena estable y fijo en el 84%. En cuanto a las condiciones de trabajo, en más del 27% se han recibido amenazas, vejaciones o exclusión laboral, y un 55% considera que tiene una carga excesiva de trabajo. En relación a la formación, el 64% ha recibido al menos 20 h en el último año, pero solo 21% ha publicado en los últimos 3 años. Conclusiones: Los especialistas en Medicina del trabajo conforman un colectivo envejecido con una edad media de 50 años y con la tasa de reposición más baja de todas las especialidades médicas, que cuenta con condiciones laborales estables y retribuciones medias entre 45-50 mil euros anuales. Encontramos diferencias según la modalidad de servicio de prevención en donde se trabaja. y con contratos por cuenta ajena estable y fijo en el 84%. En cuanto a las condiciones de trabajo, en más del 27% se han recibido amenazas, vejaciones o exclusión laboral, y un 55% considera que tiene una carga excesiva de trabajo. En relación a la formación, el 64% ha recibido al menos 20 h en el último año, pero solo 21% ha publicado en los últimos 3 años. Conclusiones: Los especialistas en Medicina del trabajo conforman un colectivo envejecido con una edad media de 50 años y con la tasa de reposición más baja de todas las especialidades médicas, que cuenta con condiciones laborales estables y retribuciones medias entre 45-50 mil euros anuales. Encontramos diferencias según la modalidad de servicio de prevención en donde se trabaja

Introduction: By perfoming this study it is intended to know the conditions in which Specialists in Occupational Medicine work in Spain. Methodology: Development of a survey with 57 questions answered anonymously, dealing with general aspects of socio-economic, demographic, organizational, training and psychosocial environment, in digital format distributed by email among specialists in occupational medicine nationwide of the different scientific societies. Results: Obtained n = 478 complete surveys, with homogeneous distribution in relation to sex (women 51% vs. Man 49%) with an average age of 50,72 years, being more than 45% over 55 years. Average compensation between 45-50 thousand euros gross / year with distribution in SPA (41%) vs SPP (37%) and with contracts for stable and fixed third-party accounts in 84%. Threats, harassment or labor exclusion have been received in more than 27%, and 55% consider that they have an excessive workload. In relation to training, 64% have received at least 20 hours in the last year, but only 21% have published in the last 3 years. Conclusion: The specialists in Occupational Medicine make up an aged group with an average age of 50 years and with the lowest replacement rate of specialist training, which has stable working conditions and average salaries between 45-50 thousand euros per year. We found differences according to the type of prevention service where you work

Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis. / Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis.

BACKGROUND: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. METHODS: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. RESULTS: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). CONCLUSIONS: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures.

[Septic arthritis of the knee by Staphylococcus warneri]. / Artritis séptica de rodilla por Staphylococcus warneri.

Septic arthritis usually occurs as an acute joint process that can cause a rapid destruction of the cartilage, if the necessary therapeutic measures were not taken. Rarely, Staphylococcus warneri may be the cause of this pathology although due to its diagnostic difficulty we can make mistakes in its treatment. We present the case of a patient with septic arthritis of the knee by this germ and we intend to remark what are the diagnostic measures and recommendations to consider for this osteoarticular infection.

La artritis séptica suele presentarse como un proceso articular agudo que puede provocar una rápida destrucción del cartílago, si no se toman las medidas terapéuticas necesarias. De manera poco frecuente, el Staphylococcus warneri puede ser la causa de esta patología aunque por su dificultad diagnóstica podemos cometer errores en su tratamiento. Presentamos el caso de un paciente con artritis séptica de rodilla por este germen y pretendemos remarcar cuáles son las medidas diagnósticas y recomendaciones a tener en cuenta para esta infección osteoarticular.

Return to work after general surgery: a comparative study / Vuelta al trabajo en cirugía general: estudio comparativo

Purposes. There is scarce information on the time to return to work after general surgery. The aim of this study was to analyze time off work after elective cholecystectomy and to compare the results with those in patients undergoing other surgical interventions. Methods. Observational and comparative study. Inclusion criteria were: being of working age and undergoing elective laparoscopic cholecystectomy (group 1) or unilateral inguinal hernia or haemorrhoidectomy (group 2). Results. 36 patients were included: 18 patients in each group. Overall, return to work occurred at a mean of 35.7 days, with no significant differences (p = 0.656) between groups (group 1: 36.6 days vs. group 2: 35.44 days). The reasons for not returning to work earlier were fear of complications (37.5%), pain control (37.5%), surgeon recommendation (12.5%), and general practitioner recommendation (12.5%). Conclusions. Time to recovery after laparoscopic cholecystectomy is prolonged. No statistically significant differences with less complex surgical procedures were detected (AU)

Objetivos. Existe escasa información acerca de la vuelta al trabajo tras una cirugía general. El objetivo de este estudio fue el de analizar el tiempo de ausencia del trabajo tras una colecistectomía electiva, comparando los resultados con los de aquellos pacientes sometidos a otras intervenciones quirúrgicas. Métodos. Estudio observacional y comparativo. Los criterios de inclusión fueron: estar en edad laboral y someterse a una colecistectomía electiva laparoscópica opcional (grupo 1), cirugía por hernia inguinal unilateral o una hemorroidectomía (grupo 2). Resultados. Se incluyó a un total de 36 pacientes, 18 de ellos en cada grupo. La vuelta al trabajo se produjo a una media de 35,7 días, sin diferencias significativas (p = 0,656) entre los grupos (grupo 1: 36,6 días frente al grupo 2: 35,44 días). Los motivos de no retornar al trabajo con anterioridad fueron el miedo a las complicaciones (37,5%), el control del dolor (37,5%), la recomendación del cirujano (12,5%), y la recomendación del médico de familia (12,5%). Conclusiones. El tiempo de recuperación tras una colecistectomía laparoscópica es largo. No se detectaron diferencias estadísticamente significativas en comparación a las intervenciones quirúrgicas menos complejas (AU)

Return to work after general surgery: A comparative study.

PURPOSES: There is scarce information on the time to return to work after general surgery. The aim of this study was to analyze time off work after elective cholecystectomy and to compare the results with those in patients undergoing other surgical interventions. METHODS: Observational and comparative study. Inclusion criteria were: being of working age and undergoing elective laparoscopic cholecystectomy (group 1) or unilateral inguinal hernia or haemorrhoidectomy (group 2). RESULTS: 36 patients were included: 18 patients in each group. Overall, return to work occurred at a mean of 35.7 days, with no significant differences (p=0.656) between groups (group 1: 36.6 days vs. group 2: 35.44 days). The reasons for not returning to work earlier were fear of complications (37.5%), pain control (37.5%), surgeon recommendation (12.5%), and general practitioner recommendation (12.5%). CONCLUSIONS: Time to recovery after laparoscopic cholecystectomy is prolonged. No statistically significant differences with less complex surgical procedures were detected.

Synthesis of a heterogeneous artificial metallolipase with chimeric catalytic activity.

A solid-phase strategy using lipase as a biomolecular scaffold to produce a large amount of Cu(2+)-metalloenzyme is proposed here. The application of this protocol on different 3D cavities of the enzyme allows creating a heterogeneous artificial metallolipase showing chimeric catalytic activity. The artificial catalyst was assessed in Diels-Alder cycloaddition reactions and cascade reactions showing excellent catalytic properties.

[The geometry of the keel determines the behaviour of the tibial tray against torsional forces in total knee replacement]. / La geometría de la quilla condiciona el comportamiento de la bandeja tibial frente a fuerzas de torsión en prótesis totales de rodilla.

The keel design of the tibial tray is essential for the transmission of the majority of the forces to the peripheral bone structures, which have better mechanical proprieties, thus reducing the risk of loosening. The aim of the present study was to compare the behaviour of different tibial tray designs submitted to torsional forces. Four different tibial components were modelled. The 3-D reconstruction was made using the Mimics software. The solid elements were generated by SolidWorks. The finite elements study was done by Unigraphics. A torsional force of 6 Nm. applied to the lateral aspects of each tibial tray was simulated. The GENUTECH® tibial tray, with peripheral trabecular bone support, showed a lower displacement and less transmitted tensions under torsional forces. The results suggest that a tibial tray with more peripheral support behaves mechanically better than the other studied designs.

Pneumococcal phosphoglycerate kinase interacts with plasminogen and its tissue activator.

Streptococcus pneumoniae is not only a commensal of the nasopharyngeal epithelium, but may also cause life-threatening diseases. Immune-electron microscopy studies revealed that the bacterial glycolytic enzyme, phosphoglycerate kinase (PGK), is localised on the pneumococcal surface of both capsulated and non-capsulated strains and colocalises with plasminogen. Since pneumococci may concentrate host plasminogen (PLG) together with its activators on the bacterial cell surface to facilitate the formation of plasmin, the involvement of PGK in this process was studied. Specific binding of human or murine PLG to strain-independent PGK was documented, and surface plasmon resonance analyses indicated a high affinity interaction with the kringle domains 1-4 of PLG. Crystal structure determination of pneumococcal PGK together with peptide array analysis revealed localisation of PLG-binding site in the N-terminal region and provided structural motifs for the interaction with PLG. Based on structural analysis data, a potential interaction of PGK with tissue plasminogen activator (tPA) was proposed and experimentally confirmed by binding studies, plasmin activity assays and thrombus degradation analyses.

Lista de espera en Cirugía General y Digestiva: expectativas del paciente, calidad de vida durante la espera y grado de satisfacción / Waiting list in general and digestive surgery: Patient expectations, quality of life during waiting time and overall satisfaction

Introducción. Los recursos estructurales del Sistema Nacional de Salud son limitados y no podemos intervenir quirúrgicamente a todos los pacientes precozmente. El objetivo fue analizar la satisfacción percibida por el paciente respecto a la demora de tratamiento por la lista de espera quirúrgica en 3 tipos de cirugía. También se analizó la influencia de la expectativa del paciente y de la alteración de la calidad de vida por síntomas durante la demora sobre la satisfacción del mismo con la espera. Material y métodos. Estudio prospectivo mediante una encuesta a pacientes intervenidos quirúrgicamente. Se compararon las expectativas de espera (escala del 1 al 5), la afectación de la calidad de vida por síntomas (escala del 1 al 5) y el grado de satisfacción de los pacientes (escala del 1 al 5) respecto al tiempo en lista de espera de colelitiasis, hernia inguinal y hemorroides. Se analizaron los factores predictores de insatisfacción de los pacientes. Resultados. Se incluyó una muestra 57 pacientes. Cuando se compararon las características de los pacientes con y sin satisfacción respecto al tiempo en lista de espera, el tiempo en la lista en días (p = 0,044), la alteración en la calidad de vida por síntomas (p = 0,028) y las expectativas de un tiempo inferior (p < 0,001) fueron significativamente diferentes entre ambos grupos. En el estudio multivariado la expectativa se asoció a la insatisfacción de los pacientes respecto al tiempo esperado (OR: 3,14, IC 95%: 5,91-220,73, p < 0,001). Conclusiones. El grado de insatisfacción de los pacientes está asociado, sobre todo, a las expectativas más que al propio tiempo de demora (AU)

Introduction: The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied. Material and methods: A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed. Results: A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P = .044), the change in the quality of life due to the symptoms (P = .028), and expectations (P <. 001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P < .001). Conclusions: The level of patient dissatisfaction is associated with expectations about time in waiting list (AU)

[Waiting list in general and digestive surgery: patient expectations, quality of life during waiting time and overall satisfaction]. / Lista de espera en Cirugía General y Digestiva: expectativas del paciente, calidad de vida durante la espera y grado de satisfacción.

INTRODUCTION: The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied. MATERIAL AND METHODS: A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed. RESULTS: A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P=.044), the change in the quality of life due to the symptoms (P=.028), and expectations (P<.001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P<.001). CONCLUSIONS: The level of patient dissatisfaction is associated with expectations about time in waiting list.

[Ischial osteomyelitis in children. Two case reports]. / Osteomielitis del isquion en la infancia. A propósito de dos casos.

UNLABELLED: Ischial osteomyelitis is a bone infection that is very infrequent during childhood and is diagnosed by excluding other more frequent conditions. The definitive diagnosis is made with puncture biopsy, which allows instituting targeted antibiotic therapy. We present herein two clinical cases of two children who had a favorable course. In both cases the findings of the initial X-rays were unremarkable. The physical exam did not show total limitation of the coxofemoral joint but it did show ischial tenderness. The MRI showed images compatible with ischial osteitis. The ischial puncture biopsy was diagnostic in both cases. At the 24-month follow-up both children are leading a normal life. CONCLUSIONS: Ischial osteomyelitis is an entity to consider in children with coxalgia once other more frequent conditions have been ruled out. The diagnosis is possible with a thorough iconographic study toget.

Pneumococcal surface proteins: when the whole is greater than the sum of its parts.

Surface-exposed proteins of pathogenic bacteria are considered as potential virulence factors through their direct contribution to host-pathogen interactions. Four families of surface proteins decorate the cell surface of the human pathogen Streptococcus pneumoniae. Besides lipoproteins and LPXTG proteins, also present in other gram-positive bacteria, the pneumococcus presents the choline-binding protein (CBP) family and the non-classical surface proteins (NCSPs). The CBPs present specific structural features that allow their anchorage to the cell envelope through non-covalent interaction with choline residues of lipoteichoic acid and teichoic acid. NCSP is an umbrella term for less characterized proteins displaying moonlighting functions on the pneumococcal surface that lack a leader peptide and membrane-anchor motif. Considering the unceasing evolution of microbial species under the selective pressure of antibiotic use, detailed understanding of the interaction between pathogen and the host cells is required for the development of novel therapeutic strategies to combat pneumococcal infections. This article reviews recent progress in the investigation of the three-dimensional structures of surface-exposed pneumococcal proteins. The modular nature of some of them produces a great versatility and sophistication of the virulence functions that, in most cases, cannot be deduced by the structural analysis of the isolated modules.

First Report of Mango Malformation Disease Caused by Fusarium mangiferae in Spain.

Mango (Mangifera indica L.) malformation disease (MMD) is one of the most important diseases affecting this crop worldwide, which causes severe economic losses because of the reduction of productivity. Symptoms of MMD in Spain were observed for the first time in April of 2006 in three mango orchards in the Axarquia Region (southern Spain). Symptoms included an abnormal development of vegetative shoots with shortened internodes and dwarfed leaves and hypertrophied short and thickened panicles. In the years of 2006, 2009, and 2010, isolates of Fusarium were obtained from vegetative shoots and floral tissue of symptomatic mango trees from 21 different orchards of cvs. Keitt, Kent, Osteen, Tommy Atkins, and a variety of minor commercial cultivars, all showing typical symptoms of MMD. Different Fusarium-like strains were isolated from infected tissues. Colonies from single-spored isolates possessed dark purple-to-salmon-colored mycelium when grown on potato dextrose agar medium. On fresh carnation leaf agar medium, mycelium contained aerial conidiophores possessing three- to five-celled macroconidia and abundant microconidia in false heads from mono- and polyphialides; while cream-orange-colored sporodochia were produced on the surface of the medium, typical for Fusarium mangiferae. The identification of 37 isolates was confirmed as F. mangiferae by species-specific PCR analysis with the primer pair 1-3 F/R that amplified a 608-bp DNA fragment from all Spanish isolates as well as a representative Israeli control strain, Fus 34, also designated as MRC7560 (2). Pathogenicity using four representative isolates, UMAF F02, UMAF F10, UMAF F17, and UMAF F38 of F. mangiferae from Spain as well as isolate MRC7560, was tested on 2-year-old healthy mango seedlings cv. Keitt by inoculating 15 buds from three different trees with a 20-µl conidial suspension (5 × 107 conidia per ml) per isolate (1). This experiment was conducted twice with two independent sets of plants and at different times (March and November 2010). Typical mango malformation symptoms were detected after bud break in March 2011, 5 and 12 months after inoculation. Symptoms were observed for 60% of the inoculated buds with the four F. mangiferae Spanish isolates and 75% with the MRC7560 control strain, but not with water-inoculated control plants. Recovered isolates from the infected floral and vegetative malformed buds were identical morphologically to those inoculated, and the specific 608-bp fragment described for F. mangiferae was amplified with specific-PCR, thus fulfilling Koch's postulates. To our knowledge, this is the first report of mango malformation disease caused by F. mangiferae in Spain and Europe. References: (1) S. Freeman et al. Phytopathology 89:456, 1999. (2) Q. I. Zheng and R. C. Ploetz. Plant Pathol. 51:208, 2002.

Serotypes, virulence genes, and intimin types of Shiga toxin (verotoxin)-producing Escherichia coli isolates from healthy sheep in Spain.

Fecal swabs obtained from 1,300 healthy lambs in 93 flocks in Spain in 1997 were examined for Shiga toxin-producing Escherichia coli (STEC). STEC O157:H7 strains were isolated from 5 (0.4%) animals in 4 flocks, and non-O157 STEC strains were isolated from 462 (36%) lambs in 63 flocks. A total of 384 ovine STEC strains were characterized in this study. PCR showed that 213 (55%) strains carried the stx(1) gene, 10 (3%) possessed the stx(2) gene, and 161 (42%) carried both the stx(1) and the stx(2) genes. Enterohemolysin (ehxA) and intimin (eae) virulence genes were detected in 106 (28%) and 23 (6%) of the STEC strains, respectively. The STEC strains belonged to 35 O serogroups and 64 O:H serotypes (including 18 new serotypes). However, 72% were of 1 of the following 12 serotypes: O5:H-, O6:H10, O91:H-, O117:H-, O128:H-, O128:H2, O136:H20, O146:H8, O146:H21, O156:H-, O166:H28, and ONT:H21 (where NT is nontypeable). Although the 384 STEC strains belonged to 95 different seropathotypes (associations between serotypes and virulence genes), 49% of strains belonged to only 11. O91:H- stx(1) stx(2) (54 strains) was the most common seropathotype, followed by O128:H- stx(1) stx(2) (33 strains) and O6:H10 stx(1) (25 strains). Three strains of serotypes O26:H11, O156:H11, and OX177:H11 had intimin type beta1; 5 strains of serotype O157:H7 possessed intimin type gamma1; and 15 strains of serotypes O49:H-, O52:H12, O156:H- (12 strains), and O156:H25 had the new intimin, intimin type zeta. The majority (82%) of ovine STEC strains belonged to serotypes previously found to be associated with human STEC strains, and 51% belonged to serotypes associated with STEC strains isolated from patients with hemolytic-uremic syndrome. Thus, this study confirms that healthy sheep are a major reservoir of STEC strains pathogenic for humans.

Influence of the conformational flexibility on the kinetics and dimerisation process of two Candida rugosa lipase isoenzymes.

We have investigated the interfacial activation process of two isoenzymes from Candida rugosa (Lip1 and Lip3) using triacetin as substrate. Kinetics were coupled to inhibition experiments in order to analyse the transition between the open and closed conformers. This process was slow, particularly for Lip1, in the absence of an interface provided by the substrate or a detergent. Dimers of Lip3 were also purified and their catalytic action was closer to that of a typical esterase. In spite of the high sequence homology between Lip1 and Lip3, small changes enhance hydrophobicity in the binding pocket of Lip3 and increase the flexibility of its flap. We postulated that these factors account for the higher tendency of Lip3 to dimerise fixing its open conformation.