Prognostic Risk Factors for the Development of Compartment Syndrome in Acute Lower Limb Ischemia Patients Treated With Catheter-Directed Thrombolysis.

BACKGROUND: To determine predisposing factors that may lead to the development of compartment syndrome (CS) in patients with acute lower limb ischemia (ALLI) managed with intra-arterial catheter-directed thrombolysis (CDT). METHODS: This is a retrospective study of patients admitted between 01/2002 and 12/2015 to three university hospitals in Tampere, Turku, and Oulu, Finland, with acute or acute-on-chronic lower limb ischemia (Rutherford I-IIb). Patients managed with CDT and aspiration thrombectomies (AT) as an adjunct to CDT were included in the study. Multivariable binary logistic regression models were used to detect possible risk factors for the development of CS and its impact on the limb salvage and survival. Amputation-free survival (AFS) rates of CS and non-CS patients were compared using Kaplan-Meier survival analysis. The length of hospitalization was calculated and compared between the CS and non-CS groups. RESULTS: A total of 292 CDTs with or without ATs were performed on patients with a mean age of 71 years (standard deviation 13 years), 151 (51.7%) being male. Altogether, 12/292 (4.1%) treatment-related CS cases were registered. Renal insufficiency (odds ratio [OR] 4.27, P = 0.07) was associated with an increased risk of CS. All CS cases were managed with fasciotomies. Treatment with fasciotomy was associated with a prolonged hospitalization of a median of 7 days versus the 4 days for non-CS patients, P < 0.001. During the median follow-up of 51 months (interquartile range 72 months), 152/292 (52.1%) patients died and 51/292 (17.5%) underwent major amputations. CS was not associated with an increased risk of mortality, but it was associated with a higher risk of major amputation (OR 3.87, P = 0.027). The AFS rates of patients with or without CS did not significantly differ from each other in the long term. CONCLUSIONS: CS after CDT for the treatment of ALLI is uncommon. Renal insufficiency is associated with an increased risk of CS. Fasciotomy prolongs the hospitalization. Patients with CS are exposed to an increased risk of major amputation.

Continuous improvement of safety in the Intensive Care and Surgical environment according to UNE 179003:2013 standard: 8 years experience. / Mejora continua de la seguridad en el ámbito de un Servicio de Anestesiología y Cuidados Intensivos a través de la certificación según la norma de UNE 179003:2013: 8 años de experiencia.

INTRODUCTION: The UNE 179003:2013 standard requires compliance with protocols to reduce the risks of patients from adverse events. METHODS: A description is presented of the procedure used in the Hospital Povisa to achieve UNE 179003:2010 certification for the intensive care unit, surgical division, and post-anaesthesia recovery unit (PARU). This was based on a risk management system, focusing on pro-active analysis using failure modes and effects analysis (FMEA) with the description of causes, consequences, risk weighting, and specific risk-minimising measures. A description is also presented of the analysis of reported adverse events (reactive analysis) in the Safety in Anesthesia and Resuscitation (SENSAR) notification system and the measures implemented over an eight-year period. RESULTS: The UNE 179003:2010 certification was obtained in July 2012, and the re-certification was achieved in July 2015. A total of 66 potential risks were established, which were weighted using a risk probability index (RPI), and measures were implemented that reduced this RPI by half. It also reflects the analysis of 1114 events declared in the SENSAR system over the past eight years, allowing for the introduction of 2681 measures, of which 98.4% are fully implemented. CONCLUSION: The application of the risk management methodology allowed (a) to improve safety in the area of action by reducing the risk to which the patients are subject, and (b) to gain certification in the UNE 179003 standard.

Diffusion Monte Carlo simulations of gas phase and adsorbed D2-(H2)n clusters.

We have computed ground state energies and analyzed radial distributions for several gas phase and adsorbed D2(H2)n and HD(H2)n clusters. An external model potential designed to mimic ionic adsorption sites inside porous materials is used [M. Mella and E. Curotto, J. Phys. Chem. A 121, 5005 (2017)]. The isotopic substitution lowers the ground state energies by the expected amount based on the mass differences when these are compared with the energies of the pure clusters in the gas phase. A similar impact is found for adsorbed aggregates. The dissociation energy of D2 from the adsorbed clusters is always much higher than that of H2 from both pure and doped aggregates. Radial distributions of D2 and H2 are compared for both the gas phase and adsorbed species. For the gas phase clusters, two types of hydrogen-hydrogen interactions are considered: one based on the assumption that rotations and translations are adiabatically decoupled and the other based on nonisotropic four-dimensional potential. In the gas phase clusters of sufficiently large size, we find the heavier isotopomer more likely to be near the center of mass. However, there is a considerable overlap among the radial distributions of the two species. For the adsorbed clusters, we invariably find the heavy isotope located closer to the attractive interaction source than H2, and at the periphery of the aggregate, H2 molecules being substantially excluded from the interaction with the source. This finding rationalizes the dissociation energy results. For D2-(H2)n clusters with n≥12, such preference leads to the desorption of D2 from the aggregate, a phenomenon driven by the minimization of the total energy that can be obtained by reducing the confinement of (H2)12. The same happens for (H2)13, indicating that such an effect may be quite general and impact on the absorption of quantum species inside porous materials.

"Leaching or not leaching": an alternative approach to antimicrobial materials via copolymers containing crown ethers as active groups.

In this work, new copolymers containing either MMA and 18C6 crown-ether pendants, or PEG, MMA and 18C6 crown-ether pendants were synthesized to test the idea that sequestering structural alkali-earth ions from the bacterial outer membrane (OM) may lead to bacterial death. The copolymers were obtained either via uncontrolled radical polymerization or ATRP; the latter approached allowed us to produce not only linear copolymers but also branched Y-like structures. After checking for the capability of complexing magnesium and calcium ions, the antimicrobial activity of all copolymers was tested placing their casted plaques in contact with pure water E. coli suspensions. All plaques adsorbed alkali-earth ions and killed bacteria, albeit with different antimicrobial efficiencies. Differences in the latter characteristic were attributed to different plaque roughness. The role of the 18C6 crown-ether pendants was elucidated by pre-saturating plaques with Mg/Ca ions, the marked reduction in antimicrobial efficiency indicating that losing the latter from OM due to surface complexation does play an important role in killing bacteria at short (<5 h) contact times. At longer times, the mode of action is instead related to the poly-cationic nature acquired by the plaques due to ion sequestering.

Evaluación y manejo de los hematomas de la vaina de los rectos. Análisis de nuestra experiencia / Evaluation and management of rectus sheath hematomas. Analysis of our experience

El hematoma de la vaina de los rectos es una entidad clínica infrecuente aunque parece que su incidencia está aumentando. Los factores más frecuentemente relacionados con su aparición son la tos, los traumatismos abdominales y la anticoagulación. El diagnóstico no es fácil y requiere una prueba de imagen en la mayoría de los casos. El tratamiento suele ser conservador. La cirugía se reserva en los casos de inestabilidad hemodinámica o cuando el hematoma está infectado

Rectus sheath hematoma is an uncommon clinical entity although it appears that its incidence is increasing. Factors most frequently associated are cough, abdominal trauma, and anticoagulation. The diagnosis is not easy and a test image is required in the majority of cases. The treatment is usually conservative. Surgery must be reserved in cases of hemodynamic instability or when hematoma is infected

Rabdomiosarcoma pleomórfico de mama en el varón. Descripción de un caso y revisión de la literatura / Pleomorfic rhabdomyosarcoma of the male breast. Report of a case and review the literature

El cáncer de mama en el varón tiene una incidencia estimada del 0.5-1% representado el sarcoma menos del 1%. Su presentación en la edad adulta es excepcional, siendo más frecuente en la infancia. Los hallazgos en la mamografía son inespecíficos, la ecografía parece tener mayor utilidad y el Tac y la RMN se utilizan para la estadificación. Se recomienda la realización de una biopsia con aguja gruesa. El tratamiento de elección es la mastectomía simple sin linfadenectomía ya que no suele existir afectación ganglionar. El tratamiento adyuvante aporta pocos beneficios en adultos. El pronóstico suele ser desfavorable

Male breast cancer has an estimated incident of 0.5-1% and sarcoma represent less than 1%. Adult presentation is exceptional, being most common in childhood. Mammography findings are nonspecific, ultrasound appears to have greater utility and the CT and MRI are used for staging. Core needle biopsy is recommended. The treatment of choice is simple mastectomy without lymphadenectomy because usually there is not lymph node involvement. Adjuvant therapy has poor benefits in adults. The prognosis is usually unfavorable

Are the intertidal fish highly resistant to UV-B radiation? A study based on oxidative stress in Girella laevifrons (Kyphosidae).

Sea chub, Girella laevifrons, is a coastal fish that inhabits high intertidal rockpools along the coast of Chile. The intertidal pools where the juveniles live, are an extreme environment with high levels of ultraviolet (UV) radiation, becoming harmful to the organisms, due to oxidative stress generated by reactive oxygen species. For this reason organisms develop adaptations that allow them to survive in this complex environment. The search of biomonitor species, sensitive to UV radiation is very important in aquatic ecosystems, mainly in the southern hemisphere where depletion of the ozone layer and the consequent increase of UV radiation, have become an environmental problem. The aim of this study was to evaluate the effect of ultraviolet radiation in G. laevifrons and its possible use as UV-B radiation biomonitor specie in intertidal systems, which are very important for the Chilean fisheries. The effect of UV radiation exposure on juvenile G. laevifrons was measured through oxidative stress parameters. Catalase's activity increased with the time of exposure, unlike superoxide dismutase's activity which peaked at 2h, decreasing towards the 5th hour of irradiation. The superoxide dismutase activity in muscle tissue did not show significant differences. The lipid peroxidation and DNA damage increased in relation to exposition times. Tissue muscle's DNA damage was shown only at 5h of exposure. Significant differences between the two organs in the antioxidant capacity were observed, the liver of G. laevifrons exhibited the higher antioxidant capacity. It can be concluded that this specie exhibits effective protection mechanisms against UV radiation exposure and it is not appropriate specie as a biomonitor in intertidal systems.

[Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive streptococcus pneumoniae isolates in adult population of the Bio-Bio region, Chile. 2005-2006]. / Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile. Periodo 2005-2006.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de Streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile: Período 2005-2006 / Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive Streptococcus pneumoniae isolates in adult population of the Bio-Bio Region, Chile: 2005-2006

Las infecciones ocasionadas por Streptococcus pneumoniae constituyen un problema de salud pública. En nuestro país existe escasa información sobre aislados de procesos bacteriémicos en población adulta. Se estudió la susceptibilidad, serotipos y relación clonal de 56 aislados de S. pneumoniae desde hemocultivos, entre enero 2005 y agosto 2006, de pacientes adultos de la intercomuna Concepción-Talcahuano, Región del Bío-Bío, Chile. Se encontró resistencia a tetraciclina (21,4 por ciento), cotrimoxazol (18 por ciento), eritromicina (18 por ciento), cloranfenicol (7 por ciento) y a penicilina en un solo aislado procedente de un foco meníngeo (2 por ciento). La totalidad mostró susceptibilidad a cefotaxima, levofloxacina, moxifloxacina y vancomicina. Se demostró una amplia variedad de serotipos capsulares, con predominio de los serotipos 1, 5, 23F, 7F y 3. El análisis de macrorestricción y electroforesis en campo pulsado reveló 31 patrones electroforéticos con 12 grupos clona-les, descartando un clon predominante. De acuerdo a los resultados, al menos 80 por ciento de los serotipos de aislados de S. pneumoniae de procesos bacteriémicos están incluidos en la vacuna comercial disponible.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, sero-types and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4 percent), trimethoprim/ sulfamethoxazole (18 percent), erythromycin (18 percent), chloramphenicol (7 percent) and 1 penicillin resistant isolate from a meningeal focus (2 percent) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80 percent of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Impacto de una estrategiade seguridad del paciente, orientadaa la reducción de úlceras por presión / Impact of a patient safety strategy aimed at reducing pressure ulcers

Las úlceras por presión (UPP) constituyen un importante problemade salud que afecta a un gran número de pacientes entodos los ámbitos de la atención sanitaria. La mayoría de estaslesiones pueden ser evitadas mediante una buena prácticaenfermera.El objetivo de este trabajo es describir el proceso de aplicaciónde una estrategia específica de seguridad del paciente, así comolos resultados de la evaluación de su efectividad en términosde reducción de la incidencia de UPP y de la eficiencia, expresadaen la reducción de costes de fungible y medicación.La metodología empleada consistió en la revisión y renovacióndel protocolo existente, estableciendo nuevos estándares y metodologíade evaluación de los indicadores.Los resultados obtenidos fueron una reducción de la incidenciade UPP del 34% en dos años y una reducción de los costesderivados del fungible y la medicación del 68%. Con elprotocolo anterior el riesgo relativo de padecer UPP era 2,17veces mayor que con el nuevo (IC 95% 1,77-2,64; p = 0,000).En nuestra opinión estos resultados devienen del cambio a unaestrategia mejor definida y la implicación de los profesionalesconseguida a través de la formación y la estimulación (AU)

Pressure ulcers (PU) are an important health problem thataffects a large number of patients in all primary care settings.Most of these lesions can be avoided by implementing good nursingcare.The objective of this work is to describe the application processof a specific patient safety strategy as well as the resultsfrom the evaluation of its effectiveness in terms of reduction ofthe incidence of pressure ulcers and efficiency, expressed interms of a cost reduction of fungible materials and medication.The methodology used consisted of the review and update ofthe existing protocol, establishing new standards and methodologyfor the evaluation of the indicators.The results obtained were a 34% incidence reduction of PUsin two years and a 68% cost reduction derived from the cutdownof fungible materials and medication. With the priorprotocol, the relative risk of developing PU was 2.17 greaterthan with the new protocol (CI 95% 1.77-2.64; p = 0,000).In our opinion, these change come from the change to a betterdefined strategy and the involvement of professionals throughtraining and stimulation. (AU)

Bombas de expulsión multidrogas en Acinetobacter baumannii y resistencia a antimicrobianos / Multi-drug efflux pumps and antibiotic resistance in Acinetobacter baumannii

Los sistemas multidrogas bacterianos contribuyen al desarrollo del fenotipo de multi-resistencia presentado por cepas de Acinetobacter baumannü, patógeno intrahospi-talario, que durante los últimos años ha incrementado su importancia por la creciente resistencia a carbapenémicos. El fenotipo de multi-resistencia está otorgado por la combinación de varios mecanismos de resistencia entre los cuales se encuentran estos sistemas de bombas de expulsión. El sistema multidroga AdeABC se ha detectado en muchas de estas cepas multi-resistentes de A. baumannü y, se ha relacionado con resistencia a diversos grupos de antimicrobianos, incluidos tigeciclina y meropenem. La inhibición de dichos sistemas multidrogas permitiría aumentar la eficacia de la terapia antimicrobiana. La siguiente revisión se enfoca en las bombas de expulsión multidrogas presentes en A. baumannü, con particular énfasis en el sistema AdeABC.

Bacterial multi-drugs systems contribute to the development of multi-resistance patterns of Acinetobacter baumannii, a nosocomial pathogen of increasing importance due to its emerging resistance to carbapenems. The multi-resistance phenomena is generated by a combination of mechanisms, one of which the efflux pump system. Many of these multiresistant isolates of A. baumannii harbor genes for the AdeABC multi-drug efflux system, related with resistance to various groups of antibacterial agents, including tygecicline and meropenem. Inhibition of these systems would allow to increase the efficacy of this antimicrobial. This review focuses on the multi-drug efflux pump system oí A. baumanni with special emphasis in the AdeABC system.

Estrategia para la prevención de eventos adversos en el anciano hospitalizado / Strategy for the prevention of adverse events in the hospitalized elderly patients

La hospitalización deriva frecuentemente en una declinaciónirreversible del estado funcional, pudiendo darcomo resultado complicaciones no relacionadas con elproblema de admisión y producir una cascada de eventosadversos (EA) que pueden culminar con la disminuciónde la calidad de vida. Las causas en los pacientesmayores son múltiples y acumulativas. Nuestro objetivogeneral fue diseñar un programa específico para la prevenciónde eventos adversos relacionados con la hospitalizacióndel paciente anciano frágil, determinando paraello los factores de riesgo, tanto intrínsecos como extrínsecos,para establecer estrategias de seguridad que incluyanacciones que minimicen o eliminen los EA según laprioridad de riesgo establecida. Se trata de un estudioprospectivo de los pacientes ingresados en el hospitalque cumplen el criterio de edad mayor o igual a 80años. Las evaluaciones fueron realizadas durante 3 díasconsecutivos en 3 meses diferentes. La muestra totalanalizada fue de 133 pacientes, que representa el 20%de los pacientes ingresados en nuestro hospital duranteel período de estudio. Como resultado hemos obtenidouna valoración de los EA de la población anciana (..) (AU)

There are multiple and cumulative causes of functional declineamong hospitalized elderly patients Hospitalization itself mayfrequently cause a state of irreversible functional decline, leadingto complications not related to the initial reasons for the hospitaladmission. Moreover, this lower functional status may carry risksof adverse events, potentially reducing quality of life. Our generalgoal was to design a specific program to prevent adverse eventsrelating to hospitalized frail elderly patients. We determined intrinsicand extrinsic risk factors within our security strategies, includingactions to minimize or even mitigate adverse events accordingto a pre-established risk priority. Evaluations wereperformed over 3 consecutive days during 3 different months.Subjects of this prospective study were 133 hospitalized patients80 years old or older, representing 20% of the patients in ourcenter during the time of research. The outcome of our study is avaluation of the adverse events affecting hospitalized elderly patients,allowing the development of a plan for risk prevention,which includes specific care measures for these patients (AU)

Hermansky Pudlak syndrome: an unusual form of procto-colitis

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder consisting of oculocutaneous albinism, platelet dysfunction and systemic complications associated with lipofuscin deposition in the reticuloendothelial system. HPS has been associated with a granulomatous enterocolitis with pathologic features suggestive of Crohn's disease. It remains uncertain if HPS represents a truly distinct form of granulomatous enterocolitis. We report a series of two patients with HPS treated in Puerto Rico, and the results from medical and surgical intervention for gastrointestinal disease. Our experience with HPS patients has shown the difficult management of perineal disease similar in the management of Crohn's. However, complications from the bleeding diathesis necessitate caution during surgery and potential anesthesia complications. Furthermore, avoidance of a perineal wound is preferred, and when possible, ileostomies have fewer complications than colostomies as they do not involve the small bowel.

Puerto Rico experience with plugs in the treatment of anal fistulas

BACKGROUND: Anorectal fistula is a common problem that affects quality of life. Main objective of therapy has been to eradicate the fistula tract while preserving fecal continence. Latest good results for anal fistula treatment have been an anal fistula plug. This study was undertaken to determine if these results could be reproduced in Puerto Rico. METHOD: From January 2003 to January 2008, two experienced colorectal surgeons performed this new operation in 23 consecutive patients. A multivariable analysis was undertaken including age, sex, location of the fistula, previous surgeries, Seton placement before the insertion of the plug, continence pre and post operation, as well as close follow up. No patient with inflammatory bowel disease was included. RESULTS: We had a good result or healing of the fistula in 14 of 23 patients for a success rate of 60%. We had a subgroup of patients who did slightly better and had a healing rate of 66% compared to the 60% of the whole group. It appears to be a trend in favor of the Seton group but is not statically significant. We had 9 failures of 23 patients or 39%. Suppuration was noticed in three patients and all three had failures of the plug with recurrences. CONCLUSIONS: This new operation is another alternative to add to our armamentarium but we need to search for an operation that decreases the incidence of recurrences we had in our study while maintaining function of the sphincters.

[Mutations in gyrA and gyrB genes among strains of Gram-negative bacilli isolated from Chilean hospitals and their relation with resistance to fluoroquinolones]. / Mutaciones en genes gyrA y gyrB en cepas de bacilos Gram negativos aisladas en hospitales chilenos y su relación con la resistencia a fluoroquinolonas.

BACKGROUND: A progressive frequency of resistance to fluoroquinolones is observed among Gram-negative bacilli. AIM: To investigate the mechanism of resistance to fluoroquinolones mediated by mutations affecting gyrA and gyrB genes in strains of Gram negative bacüli isolated from CMean hospitals. MATERIAL AND METHOD: Minimal inhibitory concentration of fluoroquinolones was determined in 91 randomly selected nalidixic acid-resistant strains of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, isolated from hospitals of 12 Chilean cities. Quinolone resistance determining region (QRDR) was amplified by PCR and mutations were determined by restriction fragment length polymorphism (RFLP) and DNA sequencing. RESULTS: Strains with mutation in codon 83 of gyrA showed decreased susceptibility to ciprofloxacin with MICs ranging from 0.25 to 1024 fig/ml. The sequencing of PCR products for gyrA indicated amino acid changes in the QRDR region. One strain ofE. coli presented a double mutation, in codon 83 Ser to Leu as well as in codon 87 Asp to Asn. In strains ofK. pneumoniae, however, the change of codon 83 was Ser to Tyr, in A. baumannii was Ser to Leu and in P. aeruginosa was Thr to He. No strains with mutations affecting gyrB were found. CONCLUSIONS: Mutations in codon 83 of gyrA is a frequent genetic event involved in the mechanism leading to decreased susceptibility to fluoroquinolone in strains of Gram-negative bacilli.