Contaminación acústica en un servicio de urgencias hospitalarias / Noise pollution in a Hospital Emergency Unit

Objetivo: conocer los niveles de ruido existentes en el Servicio de Urgencias (SU) de un hospital universitario e identificar las principales fuentes que lo generan. Método: estudio observacional descriptivo. Se realizaron mediciones del ruido en las distintas áreas del SU del Hospital Universitario Sant Joan de Reus (Tarragona), entre abril y septiembre de 2016. Se utilizó un sonómetro que registraba la actividad acústica en decibelios (dB9 en un software, para su posterior análisis e interpretación). Se llevó a cabo análisis descriptivo con el programa estadístico SPSS versión 23.0. Resultados: se realizaron 42 mediciones. La media (desviación estándar o DE) de ruido en todas las áreas del SU fue de 61,38 (4,90) dB. La media (DE) de ruido en las Urgencias de Pediatría fue 58,16 (4,09) dB, en las Urgencias Generales 63,91 (3,23) dB, en la sala de espera de adultos de 62,76 (6,92) dB, en el Área de Atención Rápida de 57,43 (2,74) dB, en el Área de Observación de 59,18 (5,67) dB. Conclusiones: los niveles de ruido medidos en el SU son altos y superan los límites recomendados por la Organización Mundial de la Salud (OMS). Se identificaron como principales fuentes generadoras de ruido la megafonía, las alarmas acústicas y en especial la comunicación interpersonal, sobre todo durante los cambios de turno

Objective: to understand the noise levels existing at the Emergency Unit (ER) of a University Hospital, and to identify the main sources that generate it. Method: a descriptive observational study. Noise measurements were conducted in the different areas of the Emergency Unit of the Hospital Universitario Sant Joan de Reus (Tarragona), between April and September, 2016, using a sound level meter that recorded the acoustic activity in decibels (dB9 in software, for its subsequent analysis and interpretation). Descriptive analysis was conducted with the statistical program SPSS version 23.0. Results: forty-two (42) measurements were conducted. The mean (standard deviation or SD) noise in all areas of the Emergency Unit was 61.38 (4.90) dB. The mean (SD) noise in the Pediatric Emergency Unit was 58.16 (4.09) dB; and it was of 63.91 (3.23) dB in General Emergencies, 62.76 (6.92) dB in the Adult Waiting Room, 57.43 (2.74) dB in the Urgent Care Area, and 59.18 (5.67) dB in the Observation Area. Conclusions: the noise levels measured at the Emergency Unit are high and exceed the limits recommended by the World Health Organization (WHO). The main sources generating noise were identified as the loudspeaker system, the acoustic alarms, and particularly interpersonal communication, particularly during shift changes

Psicosis vascular en el anciano: respuesta a clozapina / Vascular psychosis in the elderly: Response to Clozapine

La enfermedad cerebro-vascular supone una de las causas de psicosis en el anciano de origen tardío más frecuentes, se acompañe o no de demencia multi-infarto. En muchos casos el paciente presenta una adecuada conservación de las funciones cognitivas o, en todo caso, no presenta criterios de demencia. En aquellos que sí, es en la demencia vascular donde los síntomas psicóticos son más frecuentes, presentándose en más de la mitad de los casos, frente a un tercio en los pacientes con demencia tipo Alzheimer. Se presenta el caso de una mujer de 92 años, sin antecedentes somáticos de interés -a excepción de una progresiva hipoacusia bilateral-, que debuta a esa edad con clínica psicótica aguda en forma de delirios de perjuicio estructurados y alucinaciones auditivas. La TAC cerebral mostró signos de atrofia córtico-subcortical. La evaluación neuropsicológica demostró cierto deterioro cognitivo, pero sin criterios clínicos de demencia. Fue refractaria a antipsicóticos atípicos de primera línea, remitiendo el cuadro tras administración de dosis bajas de clozapina. Se discuten las características clínicas de esta psicosis, así como su abordaje terapéutico (AU)

Cerebrovascular disease is a cause of late-onset psychosis in the elderly more frequent, accompanied or not, multiinfarct dementia. In many cases the patient has adequate preservation of cognitive functions or in any case, no criteria for dementia. In those that do, is in vascular dementia where psychotic symptoms are more frequent, occurring in over half cases, compared to one third of patients with Alzheimer disease. A case of a 92 year-old woman with no somatic background-except for a bilateral progressive hearing loss-, who debuted at this age with psychotic delusions structured injury and auditory hallucinations. The CT scan showed signs of cortico-subcortical atrophy. Neuropsychological examinations showed some cognitive impairment but no clinical criteria for dementia. Was refractory to first-line atypical antipsychotics, remitting symptoms after administration of low doses of clozapine. We discuss the clinical features of this psychosis, as well as its therapeutic approach (AU)

Efectividad de los ácidos grasos hiperoxigenados en la prevención 122de las úlceras vasculares. Una revisión sistemática / Hyperoxygenated fatty acid effectiveness in the prevention of thevascular ulcers

Objetivos: conocer la eficacia de los ácidos grasos hiperoxigenados (AGHO)en la prevención de las úlceras vasculares. Determinar el nivel de evidenciaexistente sobre el uso de ácidos grasos hiperoxigenados en la prevención delas úlceras vasculares. Material y método: se realizó una búsquedabibliográfica en la The Cochrane Library, The Joanna Briggs Institute, PubMed-Medline y CUIDEN. Para su evaluación se han seguido las recomendacionesdel sistema GRADE para la valoración de la evidencia y la fuerza de lasrecomendaciones. Resultados: en The Cochrane Library y en The JoannaBriggs Institute no aparece ningún documento que haga referencia a losAGHO. En el resto de bases de datos encontramos estudios observacionalesque hacen referencia a las úlceras vasculares y AGHO. Conclusiones: aun nodisponiendo de ensayos clínicos que evidencien su uso, se han venidoutilizando durante los últimos años, con resultados satisfactorios, en elcuidado de la piel de las personas con alteraciones vasculares en los miembrosinferiores. De acuerdo con la clasificación GRADE, todos los estudiosarrojan una calidad de evidencia baja, por lo cual estimamos necesario lapuesta en marcha de investigaciones que aporten mayor evidencia científica (AU)

Objectives: to determine the effectiveness of hyper-oxygenated fatty acids in theprevention of vascular ulcers. Determine the level of existing evidence the use ofhyper-oxygenated fatty acids in the prevention of vascular ulcers. Material andMethod: we performed a literature search of Cochrane Library, The Joanna Briggs Institute, PubMed, Medline and CUIDEN. For the evaluation, havefollowed the recommendations of the GRADE system for assessing evidence andstrength of recommendations. Results: The Cochrane Library and The JoannaBriggs Institute does not see any document referring to AGHO. In all otherdatabases are observational studies that relate to vascular ulcers and AGHO.Conclusions: although not having clinical trials demonstrating their use, inrecent years, have been used successfully in skin care for people with lower limbvascular disorders. According to the classification GRADE, all studies show alow-quality evidence, which we consider necessary for the implementation ofmost scientific research (AU)

Hábitos alimentarios y estilos de vida en trabajadores de servicio sometidos a turnicidad del Ayuntamiento de Las Palmas de Gran Canaria / Food habits and life styles of shift workers in the Las Palmas de Gran Canaria town council

Fundamentos: El trabajo a turnos induce hábitos de vida anómalos, lo cual se asocia a mayor morbilidad en los trabajadores. En este estudio se realiza una valoración de los hábitos nutricionales durante la semana laboral según el turno de trabajo en un grupo de trabajadores del Ayuntamiento de Las Palmas de Gran Canaria. Métodos: La población de estudio estuvo compuesta por 255 peones de limpieza viaria, 28 recolectores de recogida de residuos sólidos y 18 trabajadores del servicio de limpieza; sometidos a turnos de trabajo (mañanas, tardes, noches y rotatorio), que representan el 87% del colectivo municipal en estudio. El número de encuestas estudiadas ha sido 262. Se determinó la ingesta dietética mediante cuestionario de frecuencia de consumo de alimentos autoadministrado con ochenta y dos alimentos, junto a una valoración del turno de trabajo, estilos de vida, actividad física, hábitos de consumo de las comidas principales, actividad física, hábitos tabáquicos, formas de vivir, categoría profesional, edad y sexo. Los datos fueron analizados mediante el paquete estadístico SPSS Base v. 15.0 para entorno Windows. Se calculó el consumo medio de alimentos (gr. /día) según turnicidad. La proporción de la distribución de las variables categóricas se realizó mediante la prueba de Chi-cuadrado. Resultados: Se observa que sólo un 34% desayunan en casa al levantarse, y un 76% hacen una comida a media mañana. Los postres en la comida son fruta (50%) y pasteles o lácteos (50%), y en la cena son mayoritariamente lácteos y pasteles (70%) y en menor proporción fruta (30%). Existen pocas diferencias en función del turno, a excepción del hábito de comer entre horas o snacks. Un 30% de la población cena un vaso de leche con galletas. Conclusiones: El hábito de tomar determinados alimentos tiene relación con el turno laboral. Es necesario mejorar localidad nutricional de la totalidad del colectivo estudiado mejorando el desayuno y la cena, y disminuyendo las comidas entre horas y los picoteos. Educar tanto al colectivo en estudio como a todos los trabajadores sometidos a turnicidad, mediante estudios previos al comenzar los cambios de turnos y con Guías adaptadas a cada turno de trabajo es una necesidad a corto plazo(AU)

Background. Shift work induces anomalous life styles, associated to increased morbidity in the workers. In this study and assessment of nutritional habits is made (breakfast, meals, outer suppers and exits) during the labour week according to the work turn in a group of workers of Las Palmas de Gran Canaria Town Council. Methods: Descriptive observational study cross-sectional character. The study population was composed by 255 shiftworkers of road cleaning, 28 workers collecting of solid residues and 18 workers of the service of cleaning; put under work turns (mornings, afternoons, nights and rotator), that represent 87% of the municipal group in study. The number of studied surveys has been 262. Dietary intakes was assessed by a self registered food frequency questionnaire with eighty and two foods, next to a valuation of the work turn (shift workers), styles of life, physical activity, habits of consumption of the main meals, physical activity, tobacco habits, forms to live, professional category, age and sex. The data were analyzed by means of statistical package SPSS Base v.15.0 for surroundings Windows. The food mean consumption calculated (gr./day) according to shift work. The proportion of the distribution of the categorical variables was made by means of the test of Chi-square. Results: In this group it is observed that only a 34% have breakfast in house when rising, and a 76% make a food to mid-morning. The desserts in the food are milky fruit (50%) and pies (70%) and in smaller proportion fruit (30%). Few differences based on the turn exist, with the exception of the habit to eat between hours or snacks. A 30% of the population have supper a milk glass with cakes. Conclusions: the habit to take certain foods has relation with the labour turn. It is necessary to improve nutritional quality of the totality of the studied group being improved the breakfast and the supper, and diminishing the meals between hours and the snacks. To as much educate to the group in study like a all the submissive shift workers, by means of previous studies when beginning the changes of turns and with Guides adapted to each turn of work is a necessity in the short term(AU)

Postanesthetic brachial triceps myonecrosis in a Spanish-bred horse.

This report describes a case of postanesthetic brachial triceps myonecrosis affecting only the left forelimb of a horse. A fatal unilateral postanesthetic myonecrosis has not been previously reported in the horse. This article describes the factors in the horse's history, the anesthetic protocol, and the treatment that may have led to this condition.

Tumor carcinoide bronquial metastásico de mama / Bronchial carcinoid tumor metastatic to the breast

Los tumores carcinoides de mama son muy pocofrecuentes y pueden ser metastásicos o primarios.Sólo se puede considerar primario de mama trasdescartar las localizaciones más frecuentes.Reconocer esta diferencia es fundamental alplanificar el tratamiento, ya que requieren unmanejo terapéutico diferente

Carcinoid tumors of the breast are uncommon.These lesions may be either metastatic or primary.A primary breast lesion can only be diagnosedafter other, more frequent locations have beenexcluded. Recognizing this difference is essentialwhen planning treatment because the therapeuticmanagement differs between these types of lesions

Programa Papep: Implantación de un programa de atención a primeros episodios psicóticos / No disponible

La detección y tratamiento precoz de los trastornos psicóticos tiene una relación directa con la evolución, el pronóstico de la enfermedad y la prevención de recaídas. Desde los servicios asistenciales de Sagrat Cor, Serveis de Salut Mental se ha creado este Programa Asistencial para Primeros Episodios Psicóticos (PAPEP) con la intención de optimizar el tratamiento de la psicosis en sus fases precoces. El objetivo básico es disponer de un procedimien-to protocolizado de atención a personas que presenten un primer episodio psicótico (PEP) que contemple tanto el proceso diagnóstico como el seguimiento óptimo a corto y medio plazo. Junto a ello, se incluyen recomendaciones mínimas para la atención tanto individual como familiar de pacientes con PEP en los diferentes niveles asistenciales

The detection and early treatment of psychosis have a direct relation with the evolution, in the prognosis of the disease and the prevention of relapses. From Sagrat Cor, Serveis de Salut Mental has been created a First Psychotic Episode Assistencial Programme (PAPEP) with the aim to optimize the treatment of the psychosis in its ealy phases. The basic objective is to have a protocol of attention to people with a first psychotic episode (PEP). The intervencions contemplates the process diagnosis and the optimal treatment in the short and mid term. Next to it, minimum recommendations for the individual and family attention

Influence of the metal size in the structure of the complexes derived from a pentadentate [N(3)O(2)] hydrazone.

The influence of the metal size in the nuclearity of the complexes derived from the hydrazone ligand 2,6-bis(1-salicyloylhydrazonoethyl)pyridine [H(4)daps] has been investigated. We have synthesised a series of new complexes [M(H(x)daps)] x yH(2)O, (x = 2,3; y = 0-3) with M = Ag (1), Cd (2), Al (3), Sn (4) and Pb (6), using an electrochemical procedure. The crystal and molecular structures have been determined for the mononuclear complexes [Sn(H(2)daps)(H(2)O)(2)] x 4H(2)O (5) and [Pb(H(2)daps)(CN)][Et(4)N] (7). Complex is the first neutral Sn(II) complex derived from a pentadentate hydrazone Schiff base ligand. Complex shows the lead coordinated to the hydrazone donor set and a cyanide ligand, being the first reported complex with the lead atom coordinated to a monodentate cyanide group. Additionally, we have synthesised the lead complex using chemical conditions, in the presence of sodium cyanide which allowed us to isolate the neutral complex [Pb(H(2)daps)] (8). Evaporation of these mother liquors led the novel compound [Pb(Hdaphs)(CH(3)COO)] (9). Complex 9 shows the initial ligand hydrolysed in one of the imine bonds giving rise to a new tetradentate ligand [H(2)daphs] coordinated to the lead atom and a bidentate acetate group. Moreover, the solution behaviour of the complexes has been investigated by (1)H, (113)Cd, (117)Sn and (207)Pb NMR techniques. In particular multinuclear NMR has provided new useful data to correlate factors such as oxidation state, coordination number and nature of the kernel donor atoms due to the new coordination found in complexes 5 and 7. The comparative study of the structures of the complexes derived from this pentadentate [N(3)O(2)] hydrazone ligand let us to conclude that the metal size is a key factor to control the nuclearity of the complexes derived from the ligand [H(4)daps].

Novel peroxidase mimics: mu-Aqua manganese-Schiff base dimers.

The interaction of manganese(II) carboxylate salts [Mn(O(2)CR)(2), where R=ethane, pentane] with H(2)L(1) [N,N'-bis(3-methoxy-2-hydroxybenzaldehyde)-1,2-phenylenediamine] and H(2)L(2) [N,N'-bis(3-ethoxy-2-hydroxybenzaldehyde)-1,2-phenylenediamine] was studied. MnL(1)(O(2)CEt)(H(2)O) (1), MnL(1)(O(2)CPe(n))(H(2)O) (2), MnL(2)(O(2)CEt)(H(2)O)(2) (3) and MnL(2)(O(2)CPe(n))(H(2)O)(2) (4) were isolated and thoroughly characterised by elemental analysis, FAB mass spectrometry, infrared and (1)H NMR spectroscopy, magnetic susceptibility measurements, molar conductivities, and cyclic and normal pulse voltammetry. Compounds 1 and 2 were crystallographically characterised revealing a tetragonally elongated octahedral geometry for the manganese coordination sphere and also a dimeric nature through mu-aqua bridges. Complexes 1-4 behave as efficient peroxidase mimics in the presence of the water-soluble trap ABTS, probably due to their ease to coordinate the substrate molecule. A correlation between rhombicity of the complexes and peroxidase activity has also been established.

Syntheses and X-ray characterization of metal complexes with the pentadentate thiosemicarbazone ligand bis(4-N-methylthiosemicarbazone)-2,6-diacetylpyridine. The first pentacoordinate lead(II) complex with a pentagonal geometry.

In this paper we describe the electrochemical synthesis and characterization of new neutral manganese, iron, cobalt, nickel, copper, zinc, cadmium and lead complexes with the ligand bis(4-N-methylthiosemicarbazone)-2,6-diacetylpyridine, H4DAPTsz-Me. X-Ray structures of [Mn(H2DAPTsz-Me)(EtOH)2] 1, [Pb(H2DAPTsz-Me)] 3 and [Zn(H2DAPTsz-Me)]2.EtOH.2H2O 4, were also determined. In these complexes the ligand behaves as bis-deprotonated and SNNNS pentadentate. In the manganese complex the metal is heptacoordinated, in a distorted pentagonal-bipyramidal environment, with the N3S2 donor set of the ligand in the pentagonal girdle and two solvent molecules occupying the axial positions. In the lead complex 3 the metal is pentacoordinated, bound exclusively to the five donor atoms of the ligand, as a consequence of the existence of "inert pair effect". The bishelical zinc complex 4 shows each zinc atom with different coordination geometry, one octahedrally six-coordinate while the other is distorted tetrahedrally four-coordinate.

[Nutritional evaluation of health shift workers from the Canary Islands]. / Valoración nutricional de trabajadores sanitarios expuestos a turnicidad en Canarias.

OBJECTIVE: Shift workers are known to have increased morbidity associated to wrong habits. In this study we have evaluated the nutritional status, food habits and physical activity in health shift workers. SUBJECTS: 207 permanent morning-shift workers and 210 shift workers (3-shift system) were randomized selected from the 2,100 workers of the North Area of the Canary Island Sanitary Health System. METHODS: Dietary intake was assessed by a self-registered food frequency questionnaire. We also assessed Body Mass Index, blood lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides), physical activity, age and sex. RESULTS: Shift workers shown higher intake of red meat, eggs, fruit juices and pasta. No differences were observed in lipid levels, weight status and physical activity in relation to the shift working status. 62% of men and 37.2% of women were overweight or obese. 46% of the subjects were sedentary. CONCLUSIONS: Shift work system seems to have little influence on the food habits of health workers.

Valoración nutricional de trabajadores sanitarios expuestos a turnicidad en Canarias / Nutritional evaluation of health shift workers from the Canary islands

Objetivo: El trabajo a turnos induce hábitos de vida anómalos, lo cual se asocia al aumento de la morbilidad en los trabajadores. En este estudio se valoró el estado nutricional, los hábitos alimentarios y la actividad física de trabajadores hospitalarios sometidos a turnos. Ámbito: La población de estudio estuvo compuesta por 207 trabajadores con turno fijo de mañana y 210 con turno rotatorio (mañana, tarde y noche) seleccionados aleatoriamente entre 2.100 trabajadores. Intervenciones: La ingesta dietética se determinó mediante cuestionario de frecuencia de consumo de alimentos autoadministrado. También se determinaron índice de masa corporal, parámetros lipídicos (colesterol total, colesterol HDL, colesterol LDL y triglicéridos), actividad física, edad y sexo. Resultados: Los trabajadores sometidos a turnicidad mostraron un mayor consumo de ternera, huevos, zumos y pastas. No se encontraron diferencias significativas en cuanto a niveles lipídicos, estado ponderal ni de actividad física entre los trabajos sometidos y no a turnicidad y no. El 62% de los hombres y el 37,2% de las mujeres mostraron sobrecarga ponderal (obesidad y sobrepeso).El 46% de los individuos de la muestra presentaron sedentarismo. Conclusiones: La turnicidad en los trabajadores hospitalarios influye sólo parcialmente en los hábitos alimentarios de dicho colectivo (AU)

Objective: Shift workers are known to have increased morbidity associated to wrong habits. In this study we have evaluated the nutritional status, food habits and physical activity in health shift workers. Subjects: 207 permanent morning-shift workers and 210 shift workers (3-shift system) were randomized selected from the 2,100 workers of the North Area of the Canary Island Sanitary Health System. Methods: Dietary intake was assessed by a self-registered food frequency questionnaire. We also assessed Body Mass Index, blood lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides),physical activity, age and sex. Results: Shift workers shown higher intake of red meat, eggs, fruit juices and pasta. No differences were observed in lipid levels, weight status and physical activity in relation to the shift working status. 62% of men and 37.2% of women were overweight or obese. 46% of the subjects were sedentary. Conclusions: Shift work system seems to have little influence on the food habits of health workers (AU)

Minimal residual disease in adolescent (older than 14 years) and adult acute lymphoblastic leukemias: early immunophenotypic evaluation has high clinical value.

Investigation of minimal residual disease (MRD) in acute leukemias by immunophenotyping and/or molecular techniques is proving to be increasingly valuable for disease monitoring. In acute lymphoblastic leukemia (ALL), most MRD studies have focused on children, whereas in contrast, information on the value of MRD on adult ALL is scanty, and almost exclusively restricted to polymerase chain reaction (PCR) studies. Early response to therapy is one of the most important prognostic factors in acute leukemia, which prompted us to investigate whether or not early immunophenotypic assessment of MRD could also be a valuable tool for predicting relapse in adult patients with ALL. For that purpose we have analyzed the level of MRD during the initial phase of treatment (induction phase) by multiparameter flow cytometry in a series of 102 adolescent (older than 14 years) and adult patients with ALL. Immunophenotypic evaluation of the bone marrow (BM) at day +35 showed that patients with low MRD levels (< 0.05% leukemia-associated phenotype [LAP+] cells) had a significantly longer relapse-free survival (RFS) than patients with high MRD levels, and this prognostic influence was retained when only those patients in morphologic complete remission (mCR) at day +35 were considered (median RFS: 42 months vs 16 months; P =.001). Moreover, immunophenotyping helped to identify a small subset of patients (n = 12) with negative or low MRD levels (< 0.03% LAP+ cells) by day +14, with an excellent prognosis (projected RFS of 90% at 5 years). The contrary is true of patients who achieved late mCR (after day +35), since immunophenotypic investigation of MRD showed that, in spite of the mCR, none of the cases with more than 0.1% LAP+ cells would be relapse-free after 2 years. Multivariate analysis showed that the immunologic evaluation of MRD at day +35 was the most relevant independent prognostic parameter for adult patients with ALL, and together with age, white blood cell (WBC) count at diagnosis, and presence of the Philadelphia (Ph) chromosome, represented the most informative combination of variables for predicting relapse-free survival.