[Bibliometric study and analysis of citation networks of visual screening in primary care]. / Estudio bibliométrico y análisis de redes de citación de los screening visuales en atención primaria.

AIM: Screenings make it possible to detect anomalies that can be treated and identify patients who require referral to a specialist. The objective is to identify the different areas of research and determine the most cited publications on screening in primary care. METHODS: An analysis of publications and visualization of citation networks has been carried out using the Citation Network Explorer software. The bibliographic search was carried out with the Web of Science (WOS) database using the search term: "screening AND (vision OR eye OR ocular OR visual)". RESULTS: We analyzed 16707 publications in all fields, 23919 citation networks have been found. The number of publications has increased, with 2021 being the year with the highest number. The majority are scientific articles and the predominant language is English. The most cited article is a global meta-analysis on the prevalence of glaucoma, showing the importance of screening for its early detection since it is essential to avoid blindness. Using the clustering function we found 8 groups with a significant number of publications where we have bibliography on certain eye diseases: glaucoma, diabetic retinopathy, pediatric amblyopia, keratoconus and dry eye. CONCLUSIONS: The main areas of study in relation to screening are the detection of diseases such as glaucoma, retinopathy of prematurity, keratoconus and dry eye. As well as the detection through visual analysis of childhood amblyopia and vision loss in elderly patients. It also gives importance to performing ocular motility tests in problems of acquired brain damage.

Vitamina C, tiamina e hidrocortisona: ¿aliados en shock séptico? / Vitamin C, thiamine and hydrocortisone: allies against septic shock?

Objetivo: Determinar la efectividad del uso de un protocolo de vitamina C, tiamina e hidrocortisona en shock séptico a las dosis empleadas en el estudio Marik. Método: Estudio observacional retrospectivo antes-después que compara dos grupos de pacientes con shock séptico: grupo tratamiento (GT), tratado con el protocolo, desde enero 2019 a mayo 2020, frente a un grupo control (GC) en un periodo previo. Los objetivos principales fueron la supervivencia a los 14 y a los 28 días. Resultados: Se incluyeron 91 pacientes, 44 en GC y 47 en GT. No se encontraron diferencias estadísticamente significativas en la supervivencia a los 14 ni a los 28 días ni en la duración de estancia hospitalaria ni en la Unidad de Reanimación (REA) (p>0,05). La variación de los valores de creatinina entre los días 1 y 4 presentó una mediana de -0,04 (RIC -0,24;0,8) en el GC frente a -0,3 del GT (RIC -0,079;-0,03), p<0,05. Los valores de procalcitonina descendieron en el 27,3% de los pacientes del GC frente al 91,5% del GT (p<0,05). La necesidad de soporte vasoactivo con noradrenalina fue del 93% GC vs 76,6% GT en el día 2; 75% GC vs 55,3% GT en el día 3; 50% GC vs 27,7% GT en el día 4 (p<0,05). Conclusiones: Los datos de nuestro estudio muestran un beneficio limitado del uso del protocolo en pacientes con shock séptico, pero son necesarios estudios de mayor reclutamiento con un diseño prospectivo randomizado para asegurar el beneficio real y/o dosis óptimas. (AU)

Objective: To determine the effectiveness of using a protocol of vitamin C, thiamine and hydrocortisone for the treatment of septic shock at the doses used in the Marik study. Methods: Retrospective observational before-after study comparing two groups of patients with septic shock: treatment group (GT), treated with the protocol, between January 2019 and May 2020, versus a control group (GC) in a previous period. The primary outcomes were 14-Day and 28-Day Survival. Results: 91 patients were included, 44 in GC and 47 in GT. No statistically significant differences were found in 14-day and 28-day survival, in length of hospital or Resuscitation Unit (REA) stay (p>0.05). The median creatinine variation between days 1 and 4 was -0.04 (IQR -0.24;0.8) in the GC vs -0.3 in the GT (IQR -0.079; -0.03) (p<0.05). Procalcitonin values decreased in 27.3% of GC versus 91.5% of GT (p<0.05). The need for vasoactive drugs (noradrenaline) was 93% in GC vs 76.6% GT on day 2; 75% GC vs 55.3% GT on day 3; 50% GC vs 27.7% GT on day 4 (p<0.05). Conclusions: Our results show a limited benefit of the use of the protocol in patients with septic shock, but larger recruitment studies with a prospective randomized design are needed to ensure real benefit and/or optimal doses. (AU)

Dosificación de ceftriaxona en el paciente crítico hipoproteinémico: un factor más a tener en cuenta / Dosage of ceftriaxone in the critical hypoproteinemic patient: another factor to take into account

Introducción: El objetivo principal del estudio fue evaluar la necesidad de ajuste posológico de ceftriaxona en pacientes críticos hipoproteinémicos. Pacientes y métodos: Estudio observacional y retrospectivo, llevado a cabo en la unidad de cuidados intensivos (UCI) del Hospital General Universitario de Ciudad Real (médico-quirúrgica de 21 camas), en el que se incluyeron pacientes tratados con ceftriaxona en la UCI desde enero de 2014 a diciembre de 2019 y se clasificaron en dos grupos al inicio del tratamiento: pacientes normoproteinémicos (proteínas totales >5,5g/dl) e hipoproteinémicos (proteínas totales ≤5,5g/dl).Variables principales: Edad, sexo, APACHE II, diagnóstico-localización del foco infeccioso, estancia en UCI, dosis de ceftriaxona, pauta posológica, tratamiento antibiótico concomitante, empírico o dirigido, necesidad de cambio de tratamiento, días de antibioterapia y mortalidad. Resultados: Se incluyeron 98 pacientes (44 normoproteinémicos y 54 hipoproteinémicos). No se obtuvieron diferencias estadísticamente significativas entre las características basales de ambos grupos, exceptuando la localización del foco, siendo respiratorio con mayor frecuencia en el grupo de pacientes normoproteinémicos (p=0,044). Se obtuvieron diferencias estadísticamente significativas a favor del grupo de pacientes normoproteinémicos para: estancia en UCI (p=0,001), necesidad de cambio de tratamiento antibiótico (p=0,004), días de antibioterapia (p=0,007) y mortalidad (p=0,046). Conclusión: Los resultados terapéuticos obtenidos en el grupo de pacientes críticos hipoproteinémicos tratados con ceftriaxona ponen en evidencia la necesidad de considerar la hipoproteinemia como un factor que podría condicionar dicho resultado si se emplean las pautas posológicas de tratamiento habituales. (AU)

Introduction: The main objective of the study was to evaluate the need for posologic adjustment of ceftriaxone in critical hypoproteinemic patients. Patients and methods: Observational and retrospective study, carried out in the intensive care unit (ICU) of the General University Hospital of Ciudad Real (21-bed medical-surgical), which included patients treated with ceftriaxone in the ICU from January 2014 to December 2019 and classified into two groups at the beginning of treatment: normoproteinemic (total proteins >5.5 g/dl) and hypoproteinemic (total proteins ≤5.5g/dl) patients.Main variables: Age, sex, APACHE II, diagnosis-location of the infectious site, ICU stay, ceftriaxone dose, dosage regimen, concomitant antibiotic treatment, empirical or targeted antibiotic treatment, need to change treatment, days of antibiotic therapy and mortality. Results: 98 patients were included (44 normoproteinemics and 54 hypoproteinemics).No statistically significant differences were obtained between the basal characteristics of both groups, except for the location of the infectious site, being respiratory more frequently in the group of normoproteinemic patients (p=0.044).Statistically significant differences were obtained in favour of the group of normoproteinemic patients for: stay in ICU (p=0.001), need for change of antibiotic treatment (p=0.004), days of antibiotherapy (p=0.007) and mortality (p=0.046). Conclusion: The therapeutic results obtained in the group of critical hypoproteinemic patients treated with ceftriaxone show the need to consider hypoproteinemia as a factor that could condition such result if the usual treatment dosage guidelines are used.

Knowledge, attitudes, and behavior regarding antibiotics, antibiotic use, and antibiotic resistance in students and health care professionals of the district of Barranquilla (Colombia): A cross-sectional survey.

Objective: To evaluate the knowledge, attitudes and behavior regarding antibiotics, use of antibiotics, and antibiotic resistance in students and health care professionals of the district of Barranquilla, Colombia. Study design: Descriptive, cross-sectional. Methods: A sample of 399 respondents was selected, that included health professionals and medical students from 12 health institutions in the district of Barranquilla (Colombia), using an established stratified sampling method. Each of the respondent professionals completed a survey that included 43 items in the Likert scale. A descriptive analysis of the study variables was performed using the software SPSS version 25. Results: Most of the respondents were women (64.4%), aged between 26 and 35 years (47.6%); 28.8% were nurses and 26.1% general practitioners, with ≤10 years of professional experience (63.4%). Overall, the survey revealed that the participants had considerable knowledge about antibiotic use (89.5%-98% correct answers) and the spread of antibiotic resistance (67.4%-89% correct answers). Approximately 74% of the respondents agreed or fully agreed with the questions related to the management of infections and the provision of advice. Conclusions: The present study revealed that most of the health care professionals surveyed had a good knowledge about antibiotic use, although strategies must be developed to strengthen knowledge regarding the spread of antibiotic resistance. Likewise, it is important to identify opportunities for improvement related with access to the guidelines and/or materials necessary to treat infections and to provide advice on antibiotic use and antibiotic resistance.

Intervención asistida con animales en personas ancianas institucionalizadas / Assisted intervention with animals in institutionalized elderly people

Objetivo: Describir el uso de la intervención asistida con animales (IAA) en personas ancianas institucionalizadas. Metodología: Revisión de la literatura panorámica entre los años 2010-2019 en las bases de datos: Web Of Science, PubMed, Cinahl, Cuiden y Dialnet. Se obtuvieron 325 artículos, de los que finalmente se seleccionaron 29 para la exposición de resultados sobre la IAA. Resultados: La IAA es un tratamiento no farmacológico que proporciona mejoras en las áreas biológica, social, psíquica y fisiológica de las personas ancianas institucionalizadas. Encontramos que la IAA se puede combinar con la terapia de juegos para personas ancianas, con la terapia de orientación a la realidad y con la fisioterapia, para así combinar sus efectos. Además, se puede considerar que la IAA es una buena opción como tratamiento no farmacológico, ya que puede implantarse a toda la población anciana. Conclusiones: La implantación de la IAA para su uso en personas ancianas institucionalizadas ha demostrado mejorar la calidad de vida proporcionando múltiples beneficios, y esto se ve reforzado si se combina con otras terapias. Por último, con respecto a la sustitución del animal real por la mascota robótica observamos como los beneficios proporcionados son similares, por lo que se produce igualmente un fomento de la salud de las personas ancianas institucionalizadas (AU)

Objective: To describe the use of animal-assisted intervention in institutionalized older adults. Methodology: An exhaustive review of the literature has been carried out between the years 2010-2019 in the following databases: Web Of Science, PubMed, Cinahl, Cuiden and Dialnet. 325 articles were obtained, of which 29 were finally selected for the presentation of results on animal-assisted intervention (AAI). Results: The AAI is a non-pharmacological treatment that provides improvements in areas such as the biological, social, psychological and physiological aspects of institutionalized older adults. We found that AAI can be combined with play therapy for the older adult, with reality-oriented therapy and with physical therapy, in order to combine its effects. In addition, AAI can be considered as a good option as a non-pharmacological treatment, since it can be implanted in the entire older adults. Conclusions: The implementation of the AAI for use with institutionalized older adults has been shown to improve the quality of life, providing multiple benefits, and this is reinforced when combined with other therapies. Finally, with respect to the substitution of the real animal for the robotic pet, we observe how the benefits provided are similar, so that there is a health promotion for the institutionalized older adults (AU)

Desabastecimiento de piperacilina-tazobactam: una oportunidad para mejorar / Shortage of piperacillin-tazobactam: an opportunity to improve

Introducción: En 2017 se iniciaron los problemas de suministro nacional de piperacilina/tazobactam, pero fue en 2018 cuando nuestro centro sufrió problemas graves de escasez. El objetivo es conocer el impacto de la evaluación de indicación de piperacilina-tazobactam en el marco del Programa de Asesoramiento de Antimicrobianos (PASA) durante el periodo de desabastecimiento de 2018.Material y métodos: Se analizaron de manera prospectiva las intervenciones efectuadas por el PASA. Se recogieron variables demográficas, clínicas, antibioterapia previa, antecedentes, recomendación realizada, aceptación, curación, mortalidad atribuible a la infección y mortalidad bruta a 30 días. Asimismo, se evaluó el impacto en consumo y coste de piperacilina-tazobactam y carbapenémicos. Se compararon los casos que evolucionaron a la curación clínica y la mortalidad, entre los pacientes cuyos facultativos aceptaron o rechazaron la recomendación de modificación.Resultados: Se realizaron 181 recomendaciones (126 pacientes), el tratamiento fue adecuado en el 53,6%, 28,2% desescalada, 8,8% suspensión, 5,5% ajuste posológico y 2,2% escalada. Aceptación global 91,6%. Los antibióticos más recomendados fueron cefalosporinas acompañadas o no de anaerobicida (60%).La curación clínica fue del 85%, la mortalidad bruta 21% y la atribuible 8,7%. No se encontraron diferencias en curación clínica (p=0,068) y mortalidad (p=0,68) entre los que aceptaron y rechazaron las recomendaciones. El consumo se redujo un 58,6%, con un ahorro estimado de 204.299 euros. El consumo de carbapenémicos aumentó un 6,1%.Conclusión: La intervención del PASA sobre la prescripción de piperacilina-tazobactam ha sido mayoritariamente aceptada, eficiente, neutra en los resultados clínicos y ha evitado el desplazamiento a carbapenémicos. (AU)

Introduction: The national supply problems of piperacillin/tazobactam began in 2017, but it was in 2018 when our center suffered severe shortage problems. The objective is to know the impact of the evaluation of the indication of piperacillin-tazobactam in the framework of the Antimicrobial Stewardship Program (ASP) during the shortage period of 2018.Methods: The interventions carried out by the ASP were analyzed prospectively. Were collected: demographic and clinical variables, previous antibiotherapy, background, recommendation made, acceptance, cure, mortality attributable to the infection and gross mortality at 30 days. Likewise, the impact on consumption and cost of piperacillin-tazobactam and carbapenems was evaluated. We compared the cases that evolved to clinical cure and mortality, among patients whose physicians accepted or rejected the recommendation for modification.Results: 181 recommendations were made (126 patients), the treatment was adequate in 53.6%, 28.2% de-escalation, 8.8% suspension, 5.5% dose adjustment and 2.2% escalation. Overall acceptance was 91.6%. The most recommended antibiotics were cephalosporins with or without anaerobicide (60%).The clinical cure was 85%, the gross mortality 21% and the attributable 8.7%. No differences were found in clinical cure (p=0.068) and mortality (p=0.68) among those who accepted and rejected the recommendations. The consumption of piperacillin-tazobactam was reduced by 58.6%, with an estimated saving of 204,299 euros. The consumption of carbapenems was increased by 6.1%.Conclusion: ASP intervention on the prescription of piperacillin-tazobactam has been mostly accepted, efficient, neutral in clinical outcomes and has prevented displacement to carbapenems. (AU)

Estimulación cerebral profunda en el núcleo accumbens en pacientes con depresión resistente al tratamiento: reporte de casos / Nucleus accumbens deep brain stimulation in patients with treatment-resistant depression: report of four cases

INTRODUCCIÓN: La estimulación cerebral profunda (DBS) se ha propuesto como una alternativa terapéutica para el manejo de la depresión resistente al tratamiento (DRT). Sin embargo, existen múltiples blancos para neuroestimulación y se desconoce el punto neuroanatómico óptimo en esta patología. Como parte del circuito de recompensa, el núcleo accumbens (NAc) ha sido estudiado en modelos de depresión y anhedonia. El objetivo de este artículo fue describir la experiencia clínica de la implantación de electrodos bilaterales de DBS en el NAc. REPORTE DE CASOS: Se describe la experiencia en cuatro mujeres entre los 17 a 41 años con DRT. Los casos presentaban antecedente de múltiples hospitalizaciones e intentos de suicidio serios, a pesar de haber sido tratadas previamente con terapia farmacológica, psicoterapia y TECAR (Terapia electroconvulsiva con anestesia y relajación). A los 6 meses del inicio del DBS, se observó una mejoría de los síntomas depresivos en la escala de Hamilton y un incremento en la escala de funcionalidad global. La anhedonia y la abulia persistieron luego de la cirugía, aunque con menor intensidad. CONCLUSIÓN: La DBS del NAc puede ser una estrategia efectiva en el tratamiento de pacientes con DRT, impactando en la funcionalidad y en la disminución del riesgo suicida.

INTRODUCTION: Deep brain stimulation (DBS) has been proposed as a therapeutic alternative for Treatment-resistant depression (TRD) patients. However, there are multiple targets for neurostimulation and the optimal neuroanatomical landmark for this pathology is unknown. Nucleus accumbens (NAc) is a crucial part of the reward circuit and has been studied extensively in models of depression and anhedonia. The objective of this study was to describe our clinical experience with DBS of the NAc patients with TRD. CASE SERIES: It described the experience in four females between 17 and 41 years of age. All cases presented with a history of multiple hospitalizations and serious suicide attempts, despite having been treated with optimal pharmacological regimes, psychotherapy and ECT (Electroconvulsive therapy). Six months after the initiation of DBS, an improvement in the Hamilton Depression Scale and in the Global Assessment of Functioning Scale was observed. Anhedonia and abulia persisted after the surgery, although less severe. CONCLUSION: DBS of NAc seems to offer favorable surgical outcomes in patients with TRD, impacting functionality and suicidal risk.

New viral biogeochemical roles revealed through metagenomic analysis of Lake Baikal.

BACKGROUND: Lake Baikal is the largest body of liquid freshwater on Earth. Previous studies have described the microbial composition of this habitat, but the viral communities from this ecosystem have not been characterized in detail. RESULTS: Here, we describe the viral diversity of this habitat across depth and seasonal gradients. We discovered 19,475 bona fide viral sequences, which are derived from viruses predicted to infect abundant and ecologically important taxa that reside in Lake Baikal, such as Nitrospirota, Methylophilaceae, and Crenarchaeota. Diversity analysis revealed significant changes in viral community composition between epipelagic and bathypelagic zones. Analysis of the gene content of individual viral populations allowed us to describe one of the first bacteriophages that infect Nitrospirota, and their extensive repertoire of auxiliary metabolic genes that might enhance carbon fixation through the reductive TCA cycle. We also described bacteriophages of methylotrophic bacteria with the potential to enhance methanol oxidation and the S-adenosyl-L-methionine cycle. CONCLUSIONS: These findings unraveled new ways by which viruses influence the carbon cycle in freshwater ecosystems, namely, by using auxiliary metabolic genes that act upon metabolisms of dark carbon fixation and methylotrophy. Therefore, our results shed light on the processes through which viruses can impact biogeochemical cycles of major ecological relevance. Video Abstract.

SEOM clinical guideline on hereditary colorectal cancer (2019).

In the last 2 decades, clinical genetics on hereditary colorectal syndromes has shifted from just a molecular characterization of the different syndromes to the estimation of the individual risk of cancer and appropriate risk reduction strategies. In the last years, new specific therapies for some subgroups of patients have emerged as very effective alternatives. At the same time, germline multigene panel testing by next-generation sequencing (NGS) technology has become the new gold standard for molecular genetics.

Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry.

BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.

Resultados del tratamiento de la infertilidad con el método sintotérmico en un estudio español / Results of infertility treatment with the sinto-thermal method in a Spanish study

OBJETIVO: Describir la efectividad del método sintotérmico (MST) en parejas tratadas de infertilidad en un grupo de población española. METODOLOGÍA: Estudio descriptivo retrospectivo de parejas que buscaban un embarazo y solicitaron atención durante el periodo de estudio (1994-2009). Fueron atendidas por una matrona en un centro de la sanidad pública en Madrid. Las parejas fueron derivadas desde atención primaria y especializada. Se calcularon los porcentajes netos de gestación y recién nacidos vivos, así como el tiempo para lograr el embarazo y la morbilidad. RESULTADOS: Se incluyó un total de 224 parejas que buscaban un embarazo. La media de edad de las mujeres era de 32 años (rango: 29-35), y la de los hombres de 34 años (rango: 30-38). El porcentaje obtenido de gestación fue del 41,5% (n= 93) y el de nacimientos vivos del 40,5% (n= 92). Entre las mujeres de 35 años o más se logró un embarazo en el 40,7% (n= 91). Del total de gestaciones, el 26,3% (n= 59) se lograron dentro de las 6 visitas comprendidas en el periodo del estudio, y el 15,2% (n= 34) tras finalizar dicho periodo. Sólo 5 de los 90 nacimientos vivos se produjeron después de un intento fallido de gestación. CONCLUSIONES: La alta efectividad del MST y la ausencia de efectos secundarios para las mujeres y los recién nacidos justifican que se dé la oportunidad a las parejas infértiles de recibir formación para identificar los signos de fertilidad, antes de someterlas a técnicas invasivas. El estudio es parte de una tesis doctoral defendida en 2012 en la Universidad Rey Juan Carlos de Madrid

OBJECTIVE: To describe the effectiveness of the sinto-thermal method (MST) in couples treated with infertility with a group of Spanish population. METHODOLOGY: A retrospective descriptive study of 224 couples seeking a pregnancy, who requested care during the study period (1994-2009) attended by a midwife at a public health center in Madrid. The couples arrived from primary care and from specialized care. The net pregnancy and birth rates of live babies were calculated, as well as the time to achieve pregnancy and morbidity. RESULTS: A total of 224 couples in search of a pregnancy. The average age of the women was 32 years (29-35 years), and the average age of the men was 34 years (30-38 years). The percentage obtained during pregnancy was 41.5% (n= 93) and that of live births was 40.5% (n= 92). Among women aged 35 or over, pregnancy was achieved in 40.7% (n= 91) of the couples. Of the total gestations, 26.3 (n= 59) were achieved within the six visits included in the study period, and 15.2% (n= 34) after the end of that period. Only 5 of the 90 live births occurred after a failed attempt. CONCLUSIONS: The high effectiveness of MST and the absence of side effects for women and newborns justify the opportunity for infertile couples to receive training to identify signs of fertility, before undergoing invasive techniques.The study is part of a doctoral thesis defended in 2012 at the Universidad Rey Juan Carlos of Madrid

Recomendaciones para la realización de procedimientos en el laboratorio de función pulmonar en tiempos de COVID-19 / No disponible

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Effect of a quality improvement intervention to reduce the length of stay in appendicitis.

AIM: Determine the effect of an intervention to reduce the length of stay (LOS) in appendectomies. METHODS: A four-quarter quality improvement initiative was developed after approval by the facility Quality Management Department, including educational sessions about the best practices regarding the hospital care for patients with appendicitis and recommendations to limit the LOS for no complicated appendicitis unless associated conditions were present, monitoring of the LOS and feedback to the staff and leaders. RESULTS: 692 appendectomies were performed, 365 (52.7%)) of them during the intervention. The mean LOS was 3.94 days with a decreasing trend during the study period. The complicated appendicitis had a mean LOS of 6.42 days (SD, 3.85) during the baseline and 5.27 days (SD 2.50) during the intervention (p=0.03), representing a 17.9% reduction. The not complicated appendicitis during baseline had LOS of 3.82 days (SD 4.17) with a subsequent reduction to 2.95 days (SD 1.53) in the intervention. The total saving bed days during the intervention were 338.04 days, which 254.04 days (75.2%) were in non complicated appendectomies. One patient required readmission during the intervention because of an organ space surgical site infection, with proper recovery after antibiotic treatment. CONCLUSION: Our study provides evidence about the possibility to optimize the bed use with a simple educational intervention, and should be considered a step to achieve additional reductions in the hospital stay of patients who undergo laparoscopic appendectomies.

Preservation of renal function in cardiac surgery patients with low cardiac output syndrome: levosimendan vs beta agonists.

BACKGROUND: Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function. METHODS: It is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were used. RESULTS: Up to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05). CONCLUSION: The incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively registered.

Computational capabilities at the edge of chaos for one dimensional systems undergoing continuous transitions.

While there has been a keen interest in studying computation at the edge of chaos for dynamical systems undergoing a phase transition, this has come under question for cellular automata. We show that for continuously deformed cellular automata, there is an enhancement of computation capabilities as the system moves towards cellular automata with chaotic spatiotemporal behavior. The computation capabilities are followed by looking into the Shannon entropy rate and the excess entropy, which allow identifying the balance between unpredictability and complexity. Enhanced computation power shows an increase of excess entropy, while the system entropy density has a sudden jump to values near one. The analysis is extended to a system of non-linear locally coupled oscillators that have been reported to exhibit spatiotemporal diagrams similar to cellular automata.

Identification of very long-chain (>C24) fatty acid methyl esters using gas chromatography coupled to quadrupole/time-of-flight mass spectrometry with atmospheric pressure chemical ionization source.

Gas chromatography coupled to a quadrupole time-of-flight mass analyzer (QTOF) with an atmospheric pressure chemical ionization (APCI) source has been tested to study the ionization and mass spectrometric behavior of long-chain and very long-chain polyunsaturated fatty acids (LC-PUFAs, C18-24; VLC-PUFAs, >C24). The protonated molecule ([M+H]+), measured at accurate mass, became the base peak of the spectrum for all the studied compounds and was promoted by the addition of water into the source. This fact overcame the existing difficulties for the identification of VLC-PUFAs when using an electron ionization source (EI). The extensive fragmentation of PUFAs in this source is the main drawback due to the fact that since reference standards are not commercially available, final identification relies on retention time estimation. The application of GC-APCI-QTOF to the screening of lipid extracts from the eyes of different fish species added confidence to the identification of several VLC-PUFAs. Further investigation of ion ratios allowed to predict the position of key double bonds enabling the classification of VLC-PUFAs as ω3 or ω6 compounds. VLC-PUFAs spectra found in biological samples were compared to those obtained from corresponding peaks found in heterologous expression experiments of fish's Elovl4.

SEOM clinical guidelines for the diagnosis and treatment of gastroenteropancreatic and bronchial neuroendocrine neoplasms (NENs) (2018)

NENs are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise across all sites, stages and grades. Although improved diagnostic techniques have led to earlier detection and stage migration, the improved prognosis documented over time for advanced gastrointestinal and pancreatic neuroendocrine tumors also reflect improvements in therapy. The aim of this guideline is to update practical recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification and therapeutic options are briefly discussed, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, and treatment algorithms are provided

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SEOM clinical guidelines for the diagnosis and treatment of gastroenteropancreatic and bronchial neuroendocrine neoplasms (NENs) (2018).

NENs are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise across all sites, stages and grades. Although improved diagnostic techniques have led to earlier detection and stage migration, the improved prognosis documented over time for advanced gastrointestinal and pancreatic neuroendocrine tumors also reflect improvements in therapy. The aim of this guideline is to update practical recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification and therapeutic options are briefly discussed, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, and treatment algorithms are provided.

Dermatofibrosarcoma protuberans vulvar: tres casos clínicos de localización inusual / Dermatofibrosarcoma protuberans vulvar: three clinical cases of localization unusual

RESUMEN El dermatofibrosarcoma protuberans (DFSP) es un sarcoma fusocelular de grado intermedio de malignidad con máxima incidencia en adultos entre 20 y 40 años y de localización habitualmente troncular (cabeza, cuello extremidades superiores). Se presentan tres casos de DFSP de localización excepcional a nivel vulvar. Las pacientes fueron tratadas con vulvectomía respetando márgenes de seguridad pero, debido a la idiosincrasia del tumor, presentaron recidivas locales que precisaron de una nueva cirugía. En su posterior seguimiento no presentaron recaídas y se encuentran libres de enfermedad.

ABSTRACT Dermatofibrosarcoma protuberans (DFSP) is an intermediate grade spindle-cell sarcoma with a highest incidence in adults between 20 and 40 years old and a trunk location (head, neck and arms). We introduce three case reports of vulvar DFSP considered unusual because of their location. The patients were conducted a free-margin vulvectomy but, due to the nature of the tumor, local reappearances required a second surgery. In the subsequent follow-up they did not suffer from any tumor relapse and they are currently disease-free.

Adscripción del farmacéutico a cuidados intensivos: generando sinergias / Pharmacist Adscription To Intensive Care: Generating Synergies

OBJETIVO: Evaluar la incorporación de un farmacéutico de hospital a la actividad habitual de una unidad de cuidados intensivos (UCI). DISEÑO: Estudio observacional prospectivo para evaluar las intervenciones farmacéuticas, realizadas por un farmacéutico adscrito temporalmente a una UCI, sobre las prescripciones médicas. Ámbito: UCI médico-quirúrgica con 21 camas. PACIENTES: Se incluyeron los pacientes con al menos una estancia en UCI y se excluyeron los pacientes con ingreso y alta en periodos en los que no se contó con la presencia física del farmacéutico. INTERVENCIONES: Se realizaban tras la revisión diaria de las prescripciones y se comunicaban de forma verbal o escrita al médico responsable. Variables principales: Intervenciones realizadas, grupo terapéutico de los medicamentos implicados, forma de realización de la intervención y el grado de aceptación. RESULTADOS: Se realizaron 194 intervenciones en 62 pacientes. La mayoría estaban relacionadas con aspectos de seguridad (33%) y optimización de la terapia (32%). Las más frecuentes se dirigieron a la administración de medicamentos por sonda nasogástrica (19%) y a la monitorización farmacocinética (14,4%). Los grupos de medicamentos más implicados fueron los antiinfecciosos en un 33% de los casos y los del aparato digestivo en un 27%. El 56,2% de las intervenciones se realizaron verbalmente y el 80% fueron aceptadas. CONCLUSIONES: La adscripción de un farmacéutico a una UCI y la realización de intervenciones sobre las prescripciones han permitido mejorar la seguridad y optimizar la farmacoterapia en más de la mitad de los pacientes. La alta tasa de aceptación de las mismas apoyaría la implementación de este tipo de programas en las unidades de críticos

OBJECTIVE: To evaluate incorporation of the hospital pharmacist to the routine activity of an Intensive Care Unit (ICU). DESIGN: A prospective observational study was carried out to evaluate the impact of pharmacist interventions, made by a pharmacist temporarily assigned to the ICU, upon medical prescriptions. SETTING: A medical and surgical ICU with 21 beds. PATIENTS: Patients with at least one ICU stay were included, while patients with admission and discharge in periods when the pharmacist was not present were excluded. INTERVENTIONS: The interventions were made after daily review of the prescriptions, and were communicated verbally or in writing to the supervising physician. MAIN VARIABLES: Number of interventions, therapeutic group of the drugs involved, type of intervention and degree of acceptance. RESULTS: A total of 194 interventions were made in 62 patients. The majority were related to safety aspects (33%) and the optimization of therapy (32%). The most frequent interventions were the administration of drugs via the nasogastric tube (19%) and pharmacokinetic monitoring (14.4%). The most frequently involved groups of drugs were anti-infectious agents (33%) and digestive system medications (27%). A total of 56.2% of the interventions were made verbally, and 80% were accepted. CONCLUSIONS: Pharmacist adscription to an ICU and the implementation of interventions on prescriptions have allowed improvement of safety and the optimization of pharmacotherapy in more than 50% of the patients. The high rate of acceptance of these interventions would support the implementation of such programs in critical care units