Experiencia sobre la reducción acústica nocturna en Unidades de Cuidados Críticos y Urgencias / xperience with noise reduction at night in Critical Care and Emergency Units

Las Unidades de Urgencias, Unidades de Cuidados Intensivos (UCI) y Neonatos tienen niveles altos de ruido que influyen negativamente en la calidad del sueño y en la calidad de vida de los usuarios. Las medidas del ruido en decibelios (dB) suelen ser más altas de las recomendadas por organismos como la Organización Mundial de la Salud (OMS), especialmente en las horas nocturnas, donde el descanso de los pacientes es importante para la recuperación de la salud. El Hospital Universitario Sant Joan de Reus (Tarragona) instauró unos semáforos detectores del ruido en las Unidades de Cuidados Críticos, como método de medida del ruido y sistema para concienciar, tanto a los trabajadores como a los usuarios, acerca de la necesidad de disminuir el ruido. El presente manuscrito pretende dar a conocer la experiencia llevada a cabo en unidades específicas para mejorar la calidad acústica, de forma que se pudiera valorar el efecto de instaurar semáforos para la detección continua de ruido. Se realizaron 60 medidas del ruido (dB) durante 15 días en horario de 21 a 8 horas, dos meses antes y dos meses después de instaurar los semáforos de control de ruido. Se obtuvieron medidas medias de 52,23 dB en Urgencias, 49,93 dB en Neonatos y 52 dB en UCI. Se objetivó una ligera disminución de la contaminación acústica en dos de las tres áreas valoradas tras la instauración de los semáforos, siendo significativa la diferencia en la Unidad de Neonatos. En vista de los resultados sería conveniente instaurar y mantener medidas de sensibilización y control permanente del ruido. Es prioritario establecer estrategias de actuación para disminuir el ruido y favorecer el silencio nocturno en Unidades de Cuidados Críticos.(AU)

Emergency Units, Intensive Care Units (ICUs) and Neonatal Units present high levels of noise which have a negative impact on the quality of sleep and quality of life of users. Noise measured in decibels (dBs) is usually higher than that recommended by agencies such as the World Health Organization (WHO), particularly during the night, where rest is important for health recovery in patients. The Hospital Universitario Sant Joan de Reus (Tarragona) implemented semaphores for noise detection in its Critical Care Units, as a method to measure noise and a system to create awareness, both in staff and users, about the need to reduce noise. The objective of this article is to make public the experience conducted in specific units to improve acoustic quality, in order to assess the effect of implementing semaphores for continuous detection of noise. Sixty (60) measurements (dBs) were taken during 15 days from 9 p.m. to 8 a.m., two months before and two months after implementing the semaphores for noise detection. The mean measures obtained were: 52.23 dBs in the Emergency Unit, 49.93 dBs in the Neonatal Unit, and 52 dBs in the ICU. After implementing the semaphores, a slight reduction in acoustic pollution was observed in two of the three areas assessed, with a significant difference in the Neonatal Unit. Given these results, it would be convenient to implement and maintain measures for awareness and permanent noise control. It is a priority to establish strategies of action in order to reduce the noise and achieve silence at night in Critical Care Units.(AU)

Effectiveness and safety of ferric carboxymaltose therapy in peritoneal dialysis patients: an observational study.

BACKGROUND: The efficacy of intravenous (IV) ferric carboxymaltose (FCM) has been demonstrated in haemodialysis and non-dialysis studies, but evidence is lacking in patients undergoing peritoneal dialysis (PD). METHODS: This multicentre, retrospective study evaluated the effectiveness and safety of FCM in patients on PD over 12 months. We retrospectively reviewed the electronic medical records of PD patients who initiated FCM treatment between 2014 and 2017 across seven Spanish centres. RESULTS: Ninety-one patients were included in the safety population (mean ± SD age 57.7 ± 15.0 years) and 70 in the efficacy population (mean age 50.9 ± 14.5 years). No hypersensitivity reaction, FCM discontinuation or dose adjustment due to a serious adverse event (SAE) was registered in the safety population. The most common non-SAEs reported were headache (four events), mild hypotension (three events) and hypertension (two events), among others. In the efficacy population (n = 70), 68.6% of patients achieved ferritin levels of 200-800 ng/mL, 78.4% achieved transferrin saturation (TSAT) >20%, and 62.8% achieved TSAT >20% and ferritin >200 ng/mL after 12 months of FCM initiation (P < 0.01). Haemoglobin (Hb) levels were maintained at >11 g/dL with a lower dose of darbepoetin throughout the follow-up. The sub-analysis of patients naïve to IV iron and with absolute or relative iron deficiency (n = 51) showed that 76.5% reached ferritin >200 ng/mL, 80.4% TSAT >20% and Hb increased (1.2 g/dL) after 4 months of FCM treatment (P < 0.01). CONCLUSION: In this multicentre, retrospective, real-world study conducted in the PD population, FCM was effective, safe and easy to administer during routine clinical visits.

Documento de consenso para la formación en ecografía en la especialidad de Nefrología / Consensus document for ultrasound training in the specialty of Nephrology

La ecografía es una herramienta esencial en el manejo del paciente nefrológico que permite el diagnóstico, el seguimiento y la realización de intervencionismo sobre el riñón. La utilidad de los ultrasonidos en Nefrología no se circunscribe exclusivamente al estudio ecográfico del riñón. Mediante ecografía el nefrólogo puede, además, optimizar el manejo de la fístula arteriovenosa para hemodiálisis, medir el riesgo cardiovascular (grosor íntima-media), implantar catéteres centrales para hemodiálisis ecoguiados y ayudar en la colocación de los peritoneales, así como calcular la volemia del paciente mediante ecografía cardiaca básica, ecografía de la vena cava inferior y pulmonar. Desde el Grupo de Trabajo en Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN) hemos elaborado este documento de consenso en el que se resumen las principales aplicaciones de la ecografía en Nefrología, incluyendo los requisitos técnicos básicos necesarios, el marco normativo y el nivel de capacitación de los nefrólogos en esta materia. El objetivo de este trabajo es promover la inclusión de la ecografía, tanto diagnóstica como intervencionista, en la práctica clínica habitual del nefrólogo y en la cartera de servicios de Nefrología con la finalidad de ofrecer un manejo diligente, eficiente e integral al paciente nefrológico

Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs. From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient

Consensus document for ultrasound training in the specialty of Nephrology. / Documento de consenso para la formación en ecografía en la especialidad de Nefrología.

Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs. From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient.

Synthesis of Chitosan-Polyvinyl Alcohol Biopolymers to Eliminate Fluorides from Water.

The fluoride content in groundwater varies depending on geological configuration. Fluoride problems tend to occur in places where these minerals are most abundant in rocks. The objective of the present work was to synthesize four biopolymers based on chitosan-polyvinyl alcohol (Ch-PVA) cross-linked with sodium tripolyphosphate pentabasic (TPP) and ethylene glycol diglycidyl ether (EGDE) and determine their ability to remove fluoride from water. The characterization of the Ch-PVA beads was performed by way of Scanning Electron Microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR). The percentage of humidity and the point of zero charge were determined. The Ch-PVA beads showed a surface area of 63.87 m2 g-1, a pore size of 7.6 nm, a point of zero charge of 7.4, and 98.6% humidity. The kinetic adsorption study was adjusted to the pseudo-second-order model and the adsorption equilibrium data were adjusted to the Freundlich adsorption isotherm, showing a maximum fluoride adsorption capacity of 12.64 mg.g-1 at pH 7 and 30 °C, for the beads of Ch-PVA-NaOH-TPP. According to the thermodynamic parameters: -∆Go, +∆Ho and -∆So, fluoride adsorption is spontaneous, endothermic in nature and there is no random energy change in the solid/liquid interface during the adsorption process.

Association of T and NK Cell Phenotype With the Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a pathological condition characterized by incapacitating fatigue and a combination of neurologic, immunologic, and endocrine symptoms. At present its diagnosis is based exclusively on clinical criteria. Several studies have described altered immunologic profiles; therefore, we proposed to further examine the more significant differences, particularly T and NK cell subpopulations that could be conditioned by viral infections, to discern their utility in improving the diagnosis and characterization of the patients. The study included 76 patients that fulfilled the revised Canadian Consensus Criteria (CCC 2010) for ME/CFS and 73 healthy controls, matched for age and gender. Immunophenotyping of different T cell and natural killer cell subpopulations in peripheral blood was determined by flow cytometry. ME/CFS patients showed significantly lower values of T regulatory cells (CD4+CD25++(high)FOXP3+) and higher NKT-like cells (CD3+CD16+/-CD56+) than the healthy individuals. Regarding NK phenotypes, NKG2C was significantly lower and NKCD69 and NKCD56 bright were significantly higher in the patients group. A classification model was generated using the more relevant cell phenotype differences (NKG2C and T regulatory cells) that was able to classify the individuals as ME/CFS patients or healthy in a 70% of cases. The observed differences in some of the subpopulations of T and NK cells between patients and healthy controls could define a distinct immunological profile that can help in the diagnostic process of ME/CFS patients, contribute to the recognition of the disease and to the search of more specific treatments. However, more studies are needed to corroborate these findings and to contribute to establish a consensus in diagnosis.

From Intermolecular Interactions to Texture in Polycrystalline Surfaces of 1,ω-alkanediols (ω = 10-13).

Differences on herringbone molecular arrangement in two forms of long-chain 1,ω-alkanediols (CnH2n+2O2 with n = 10, 11, 12, 13) are explained from the analysis of O-H···O hydrogen-bond sequences in infinite chains and the role of a C-H···O intramolecular hydrogen-bond in stabilization of a gauche defect, as well as the inter-grooving effectiveness on molecular packing. GIXD (Glancing Incidence X-ray Diffraction) experiments were conducted on polycrystalline monophasic samples. Diffracted intensities were treated with the multi-axial March-Dollase method to correlate energetic and geometrical features of molecular interactions with the crystalline morphology and textural pattern of samples. The monoclinic (P21/c, Z = 2) crystals of the even-numbered members (n = 10, 12; DEDOL and DODOL, respectively) are diametrical prisms with combined form {104}/{-104}/{001} and present a two-fold platelet-like preferred orientation, whereas orthorhombic (P212121, Z = 4) odd-numbered members (n = 11, 13; UNDOL and TRDOL, respectively) present a dominant needle-like orientation on direction [101] (fiber texture). We show that crystalline structures of medium complexity and their microstructures can be determined from rapid GIXD experiments from standard radiation, combined with molecular replacement procedure using crystal structures of compounds with higher chain lengths as reference data.

Tuberculosis osteoarticular: presentación de 2 casos / Osteoarticular tuberculosis: report of two cases

Introducción: La tuberculosis continúa siendo una enfermedad de considerable prevalencia en nuestro país a pesar de su disminución desde los años 90. La tuberculosis osteoarticular ocupa el tercer lugar de la localización de las tuberculosis extrapulmonares. Por su difícil diagnóstico es importante tenerla en consideración, principalmente en pacientes sin alteraciones inmunológicas y sin antecedentes familiares o de contacto. Casos clínicos: Presentamos 2 casos de infección tuberculosa osteoarticular como primera manifestación de la enfermedad en pacientes aparentemente sanos y sin antecedentes epidemiológicos acontecidos en nuestro hospital. El tratamiento que se realizó asociando antituberculosos y una limpieza articular consiguió un buen resultado clínico-funcional. Estos casos demuestran una sintomatología inespecífica durante períodos de tiempo muy largos y, por tanto, su dificultad diagnóstica. Conclusión: Señalar la dificultad diagnóstica de la tuberculosis osteoarticular y la necesidad de pensar en este cuadro ante procesos osteoarticulares subagudos, así como la necesidad de un tratamiento combinado farmacológico y quirúrgico (AU)

Introduction: Tuberculosis remains a significantly prevalent disease in our country despite its decline since the 1990s. Osteoarticular tuberculosis is the third most common type of extrapulmonary tuberculosis. Since it is difficult to diagnose, it is important to consider its possible occurrence, especially in patients with no immunological abnormalities and no family or contact history. Clinical reports: We present two cases of osteoarticular tuberculosis infection that were the first manifestation of the disease in apparently healthy patients with no epidemiological history. The treatment was a combination of antituberculosis drugs and joint lavage, and a good clinical and functional outcome was achieved. These cases show the absence of specific symptoms for long periods of time and, therefore, the difficulty to diagnose the disease. Conclusion: Diagnosing osteoarticular tuberculosis is difficult, and there is a need to be aware of this clinical condition in subacute osteoarticular processes, as well as a need for a combination of pharmacological and surgical treatment (AU)

Diagnóstico clínico y de laboratorio de la artritis gonocócica: a propósito de un caso / Clinical and laboratory diagnosis of gonococcal arthritis: presentation of a case

Introducción. La artritis gonocócica es una patología infrecuente en países de Europa occidental. Conseguir un diagnóstico temprano es vital para evitar una diseminación sistémica potencialmente fatal. Un caso en el trabajo rutinario de nuestro laboratorio, nos invita a realizar una breve revisión sobre la fisiopatología y el diagnóstico de la enfermedad. Observación clínica. Varón de 64 años, con fiebre, poliartralgias, e inflamación en tobillo derecho. Se procede a artrococentesis obteniendo muestra de líquido sinovial, con resultados analíticos sugerentes de artritis infecciosa, verificada mediante cultivo con aislamiento de N. gonorrhoeae, que el antibiograma muestra sensible a penicilina y ceftriaxona. Discusión. La infección diseminada de N. gonorrhoeae (DGI) incluye signos como poliartralgias, tenosinovitis y dermatitis. Ciertos casos pueden cursar además con artritis monoarticular, asociada a cultivos positivos de líquido sinovial, aunque hemocultivos negativos. Los elevados índices de resistencia a penicilina y tetraciclina, obligan a recomendar ceftriaxona i.v. como tratamiento de elección. Conclusión. La artritis gonocócica puede cursar en pacientes sin lesiones en la mucosa genitourinaria. Se asocia comúnmente a hemocultivos negativos. Solo el aislamiento del microorganismo en líquido sinovial permite un diagnóstico definitivo (AU)

Introduction. Gonococcal arthritis is an uncommon disease in western European countries. Obtaining an early diagnosis is essential to prevent potentially fatal dissemination. A case in the routine work of our laboratory led us to present a short review of the pathophysiology and diagnosis of the disease. Clinical observation. A 64 year-old male with, a fever, multiple joint pains, and inflammation in the right ankle. A sample of synovial fluid was obtained by arthrocentesis, with analytical results suggestive of infectious arthritis. This was confirmed by a culture, with the isolation of N. gonorrhoeae, which the antibiogram showed susceptibility to penicillin and ceftriaxone. Discussion. Disseminated N. gonorrhoeae infection includes signs such as, multiple joint pains, tenosynovitis and dermatitis. Certain cases can also present with, single joint arthritis, combined with positive synovial fluid cultures, although with negative blood cultures. The elevated rates of resistance to penicillin and tetracycline require recommending IV ceftriaxone as the treatment of choice. Conclusion. Gonococcal arthritis can occur in patients without lesions in the genitourinary mucosa. It is commonly associated with negative blood cultures. Only the isolation of the microorganism in synovial fluid enables a definitive diagnosis to be made (AU)

Úlcera corneal con hipopión en paciente diabético y bronquítico crónico / Corneal ulcer with hypopyon in a patient with diabetes and chronic bronchitis

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Fracturas metafisaria proximal del cúbito y epifisiolistesis radial proximal tipo II de Salter-Harris, con desplasamiento total y luxación de la cabeza radial. Equivalente de la lesión de Monteggia tipo IV: informe de un caso / Non-displaced proximal metaphyseal fracture of the ulna and Salter-Harris Class-II leteral slipping and dislocation of the radial head. An equivalent to the Class IV Monteggia lesion: case report

Se presenta el caso de una niña con fractura metafisaria proximal del cúbito y deslizamiento epifisario traumático lateral tipo II de Salter y Harris, que se considera como un equivalente de la fractura-luxación de Monteggia, cuya rareza en cuanto a su frecuencia justifica su publicación