[Characterization and risk prediction of cardiovascular surgeries with cardiopulmonary bypass: a cross-sectional study] / Caracterización y predicción del riesgo de cirugías cardiovasculares con uso de bomba de circulación extracorpórea.

Introduction: Cardiovascular surgery risk prediction models are widely applied in medical practice. However, they have been criticized for their low methodological quality and scarce external validation. An additional limitation added in Latin America is that most of these models have been developed in the United States or Europe, which present marked geographical differences. The objective of this study is to characterize the postoperative clinical events of cardiovascular surgeries with the use of cardiopulmonary bypass pump in a local setting and to evaluate the prediction of postoperative mortality using the EuroSCORE II predictive model. Methods: Cross-sectional study in an urban university hospital in Buenos Aires. Patients ≥21 years of age were included, with a clinical indication for on-pump cardiovascular surgery. Patients with incomplete clinical data regarding EuroSCORE II variables or in-hospital survival, ≥95 years of age, or undergoing heart transplantation were excluded. Results: 195 patients were enrolled. Postoperative mortality estimated by EuroSCORE II presented a clear underestimation of risk (3.0% vs 7.7%). Discrimination (AUC = 0.82; 95% CI 0.74-0.92) and goodness of fit of the model were adequate (χ2 = 7.91; p = 0.4418). The most frequent postoperative complications were postoperative heart failure (35.9%), vasoplegic shock (13.3%), and cardiogenic shock (10.26%). Conclusion: The EuroSCORE II is an appropriate tool to discriminate between different risk categories in patients undergoing on-pump cardiovascular surgery, although it underestimates the risk.

Introducción: Los modelos de predicción de riesgo de cirugías cardiovasculares se aplican ampliamente a la práctica médica. Sin embargo, han sido criticados por su baja calidad metodológica y escasa validación externa. En América Latina se agrega la limitación de que la mayoría de estos modelos fueron desarrollados en Estados Unidos o Europa, existiendo diferencias geográficas marcadas. Objetivo: El objetivo de este estudio es caracterizar los eventos clínicos postoperatorios de cirugías cardiovasculares con uso de bomba de circulación extracorpórea en un escenario local y evaluar la predicción de mortalidad postoperatoria del modelo predictivo EuroSCORE II. Métodos: Corte transversal en un hospital universitario urbano de Buenos Aires. Se incluyeron a pacientes ≥21 años de edad, con indicación de cirugía cardiovascular con uso de bomba. Se excluyeron a pacientes con datos clínicos incompletos respecto a las variables del EuroSCORE II o respecto a la sobrevida intrahospitalaria, con ≥95 años de edad o sometidos a trasplante cardíaco. Resultados: Se enrolaron 195 pacientes. La mortalidad postoperatoria estimada por el EuroSCORE II presentó una clara subestimación del riesgo (3,0% vs 7,7%). La discriminación (AUC = 0,82; IC95% 0,74-0,92) y la bondad del ajuste del modelo fueron adecuadas (χ2 = 7,91; p = 0,4418). Las complicaciones postoperatorias más frecuentes fueron insuficiencia cardíaca postoperatoria (35,9%), shock vasopléjico (13,3%) y shock cardiogénico (10,26%). Conclusión: El EuroSCORE II es una herramienta apropiada para discriminar entre diferentes categorías de riesgo en pacientes sometidos a cirugías cardiovasculares con uso de bomba, si bien subestima el riesgo.

Increase in records of toxic phytoplankton and associated toxins in water samples in the Patagonian Shelf (Argentina) over 40 years of field surveys.

Historical records (1980-2018) of potentially toxic phytoplankton and phycotoxins on the Argentine Continental Shelf (35°S-56.5°S) and adjacent ocean waters were systematically reviewed from scientific literature to assess their abundance and diversity over spatial and temporal scales. Records increased from 124 in the period 1980-1992 to 638 in 2006-2018, and the scanned area expanded from coastal to offshore waters including the shelf-break front. Alexandrium was the most reported genus (54%) during 1980-1992 and Pseudo-nitzschia (52%) during 1993-2005. By 2006-2018, a higher diversity was documented: Alexandrium (20%), Dinophysis (32%), Pseudo-nitzschia (31%), and the most recently described potentially toxic dinoflagellates of the family Amphidomataceae (8%). Likewise, a wider spectrum of phycotoxins was documented in the last decade, with lipophilic (LSTs) and paralytic shellfish toxins (PSTs) as the most recorded. Increased records are related to intensified monitoring, more detailed taxonomic analyses and more sensitive chemical techniques for marine biotoxin detection. This quantitative assessment brings light to the widespread occurrence of HABs along contrasting areas of the Patagonian Shelf and sets the basis for ecosystem risk evaluation. Moreover, comparison of toxic phytoplankton reported in the SW Atlantic with those in similar temperate seas in the North Atlantic and the Pacific Ocean, disclose ocean basin differences in strain toxicity of A. ostenfeldii, D. tripos and Azadinium species.

Acute kidney injury following cardiopulmonary bypass in Jamaica.

Objectives: The study objectives were to describe the incidence, risk factors, and outcomes of acute kidney injury after cardiopulmonary bypass in Jamaica. Method: We performed a review of the medical records of adult patients (aged ≥ 18 years) with no prior dialysis requirement undergoing cardiopulmonary bypass at the University Hospital of the West Indies, Mona, between January 1, 2016, and June 30, 2019. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Acute kidney injury was defined using Kidney Disease Improving Global Outcomes criteria. The primary outcomes were acute kidney injury incidence and all-cause 30-day mortality. Multivariable logistic regression and Cox proportional analyses were used to examine the association between the acute kidney injury risk factors and the primary outcome. Results: Data for 210 patients (58% men, mean age 58.1 ± 12.9 years) were analyzed. Acute kidney injury occurred in 80 patients (38.1%), 44% with Kidney Disease Improving Global Outcomes I, 33% with Kidney Disease Improving Global Outcomes II, and 24% with Kidney Disease Improving Global Outcomes III. From multivariable logistic regression models, European System for Cardiac Operative Risk Evaluation II (odds ratio, 1.19; 95% confidence interval, 1.01-1.39 per unit), bypass time (odds ratio, 1.94; 95% confidence interval, 1.40-2.67 per hour), perioperative red cell transfusion (odds ratio, 3.03; 95% confidence interval, 1.36-6.76), and postoperative neutrophil lymphocyte ratio (odds ratio, 1.65; 95% confidence interval, 1.01-2.68 per 10-unit difference) were positively associated with acute kidney injury. Acute kidney injury resulted in greater median hospital stay (18 vs 11 days, P < .001) and intensive care unit stay (5 vs 3 days, P < .001), and an 8-fold increase in 30-day mortality (hazard ratio, 8.15; 95% confidence interval, 2.76-24.06, P < .001). Conclusions: Acute kidney injury after cardiopulmonary bypass surgery occurs frequently in Jamaica and results in poor short-term outcomes. Further studies coupled with quality interventions to reduce the mortality of those with acute kidney injury are needed in the Caribbean.

Design of a Fuzzy Logic Evaluation to Determine the Ergonomic Risk Level of Manual Material Handling Tasks.

In this work, we propose a fuzzy inference as a decision support system built in the MATLAB Fuzzy Logic Designer for evaluating manual material handling risk conditions. The input variables for the fuzzy decision were: (1) the total time duration of the manual material handling in one shift of 450 min, with 3 h considered the maximal exposition time; (2) 25 kg as a maximal mass reference which should never be exceeded; (3) the repetitiveness of the manual material handling task through the shift considering as the maximal frequency of four lifts per min. Results of 135 earlier direct ergonomic evaluations made using the method proposed by the ISO 11228-1 were used as validator results, and called "expected results". The experimentation intended to simulate an ergonomic evaluation in different boundary conditions of work and verify if the fuzzy interface could correctly replicate the results of the ergonomic evaluations. As validation, the list with the 135 expected results was compared against the evaluation made by the fuzzy logic interface, called "Work_Conditions". From the comparison, only three evaluations (0.02%) differed with respect to the expected results. Consequently, it is concluded that the fuzzy interface can be used as a tool for automating the determination of manual material handling ergonomic risk levels, with great precision.

Cybernetic governance of the Peruvian State: a proposal.

This paper aims to make a proposal to govern the Peruvian State under the umbrella of management cybernetics, following the paths of the viable system model (VSM), proposed by Prof. Stafford Beer, enriched with other soft and hard systemic methodologies and technologies, to cover the soft and hard issues that are part of the complex Peruvian reality at different levels of recursion. For doing this, four defined perspectives were adopted to understand the complexity of Peru: the sectoral view, the regions view, the river basins view and the macroregions view. Peru is seen as a system in focus, defining, for each of these four perspectives, the five systems that VSM has. The application of the VSM in each perspective serves to apply it in two modes: diagnosis and design, according to the respective perspective. Then an integrative analysis and reflection is done considering the four perspectives, to analyze the viability of the VSM approach in the governance of the Peruvian State to establish some conclusions and recommendations in relation to the proposal, appearing at the end of the paper.

A Change in Conservation Status of Pachyphytum caesium (Crassulaceae), a Threatened Species from Central Mexico Based on Genetic Studies.

Genetic studies in rare species are important to determine their patterns of genetic diversity among populations and implement conservation plans aimed to reduce extinction risks. Pachyphytum caesium is an endemic species with extremely small populations in central Mexico. This work analyzes the diversity and genetic structure of Pachyphytum cesium (Crassulaceae) to change the conservation status and propose conservation strategies. Twelve dominant ISSR markers were used to describe the genetic diversity of all known populations. Additionally, we carried out two simulations to explore how the loss of individuals or the local populations extinction affect the genetics parameters of the species. The average results indicated moderate levels of genetic diversity (number of alleles = 89.7 ± 3.9, expected heterozygosity = 0.212 ± 0.0, and percentage of polymorphic loci = 56.1 ± 3.9), parameters that decreased significantly when simulations were performed in P. caesium. Additionally, a genetic structure of the populations was found with low gene flow (Nm = 0.92). Genetic parameters are negatively affected by the loss of individuals and the local extinction of populations. Based on our results, we propose to reclassify the conservation status of the species in danger of extinction, hence a series of conservation strategies are provided to prevent its disappearance.

The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying-the head and neck cancer model.

PURPOSE: The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time-to-treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. METHODS: An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. RESULTS: The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time-to-treatment initiation. CONCLUSIONS: This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.

Multicenter prospective validation of the EuroSCORE II in Argentina.

Objective: To validate prospectively in multiple centers, the accuracy and clinical utility of the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) to predict the operative mortality of cardiac surgery in Argentina. Methods: Between January 2012 and February 2018, 2,000 consecutive adult patients who underwent cardiac surgery in different centers in Argentina were prospectively included. The end-point was in-hospital all-cause mortality. Discrimination, calibration, precision and clinical utility of the EuroSCORE II were evaluated in the global cohort and in the different types of surgeries, based on ROC (Receiver Operating Characteristics) curves, Hosmer-Lemeshow goodness-of-fit test, observed/expected mortality ratio, Shannon index and decision curves analysis. Results: ROC area of the EuroSCORE II was between 0.73 and 0.80 for all types of surgery, being the lowest value for coronary surgery. The observed and expected mortality was 4.3% and 3.0%, respectively (p = 0.034). The decision curve analysis showed a positive net benefit for all thresholds below 0.24, considering all type of surgeries. Conclusion: The EuroSCORE II showed an adequate performance in terms of discrimination and calibration for all types of surgery, although somewhat inferior for coronary surgery. Though in general terms this model underestimated the risk in intermediate risk groups, its overall performance was acceptable. The EuroSCORE II could be considered an optional updated generic model of operative risk stratification to predict in-hospital mortality after cardiac surgery in our context.

Objetivo: Validar, en forma prospectiva y en múltiples centros, la precisión y utilidad clínica del European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) para predecir la mortalidad operatoria de la cirugía cardíaca en centros de Argentina. Método: Entre enero de 2012 y febrero de 2018 se incluyeron en forma prospectiva 2,000 pacientes consecutivos que fueron sometidos a cirugía cardíaca en diferentes centros de Argentina. El punto final fue mortalidad hospitalaria por cualquier causa. La discriminación, calibración, precisión y utilidad clínica del EuroSCORE II se evaluaron en la cohorte global y en los diferentes tipos de cirugías, basándose en las curvas Receiver Operating Characteristics (ROC), bondad de ajuste de Hosmer-Lemeshow, razón de mortalidad observada/esperada, índice de Shannon y curvas de decisión. Resultados: El área ROC del EuroSCORE II estuvo entre 0.73 y 0.80 para todo tipo de cirugía, y el valor más bajo fue para la cirugía coronaria. La mortalidad observada y esperada fue 4.3 y 3.0%, respectivamente (p = 0.034). El análisis de la curva de decisión demostró un beneficio neto positivo para los umbrales por debajo de 0.24 para todo tipo de cirugía. Conclusiones: El EuroSCORE II tuvo un desempeño adecuado en términos de discriminación y calibración para todos los tipos de cirugía, aunque algo inferior para la cirugía coronaria. Si bien en términos generales subestimó el riesgo en los grupos de riesgo intermedio, el comportamiento global fue aceptable. El EuroSCORE II podría considerarse una opción de modelo genérico y actualizado de estratificación del riesgo operatorio para predecir la mortalidad hospitalaria de la cirugía cardíaca en nuestro contexto.

Validación prospectiva multicéntrica del EuroSCORE II en Argentina / Multicenter prospective validation of the EuroSCORE II in Argentina

Resumen Objetivo: Validar, en forma prospectiva y en múltiples centros, la precisión y utilidad clínica del European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) para predecir la mortalidad operatoria de la cirugía cardíaca en centros de Argentina Método: Entre enero de 2012 y febrero de 2018 se incluyeron en forma prospectiva 2,000 pacientes consecutivos que fueron sometidos a cirugía cardíaca en diferentes centros de Argentina. El punto final fue mortalidad hospitalaria por cualquier causa. La discriminación, calibración, precisión y utilidad clínica del EuroSCORE II se evaluaron en la cohorte global y en los diferentes tipos de cirugías, basándose en las curvas Receiver Operating Characteristics (ROC), bondad de ajuste de Hosmer-Lemeshow, razón de mortalidad observada/esperada, índice de Shannon y curvas de decisión. Resultados: El área ROC del EuroSCORE II estuvo entre 0.73 y 0.80 para todo tipo de cirugía, y el valor más bajo fue para la cirugía coronaria. La mortalidad observada y esperada fue 4.3 y 3.0%, respectivamente (p = 0.034). El análisis de la curva de decisión demostró un beneficio neto positivo para los umbrales por debajo de 0.24 para todo tipo de cirugía. Conclusiones: El EuroSCORE II tuvo un desempeño adecuado en términos de discriminación y calibración para todos los tipos de cirugía, aunque algo inferior para la cirugía coronaria. Si bien en términos generales subestimó el riesgo en los grupos de riesgo intermedio, el comportamiento global fue aceptable. El EuroSCORE II podría considerarse una opción de modelo genérico y actualizado de estratificación del riesgo operatorio para predecir la mortalidad hospitalaria de la cirugía cardíaca en nuestro contexto.

Abstract Objective: To validate prospectively in multiple centers, the accuracy and clinical utility of the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) to predict the operative mortality of cardiac surgery in Argentina. Methods: Between January 2012 and February 2018, 2,000 consecutive adult patients who underwent cardiac surgery in different centers in Argentina were prospectively included. The end-point was in-hospital all-cause mortality. Discrimination, calibration, precision and clinical utility of the EuroSCORE II were evaluated in the global cohort and in the different types of surgeries, based on ROC (Receiver Operating Characteristics) curves, Hosmer-Lemeshow goodness-of-fit test, observed/expected mortality ratio, Shannon index and decision curves analysis. Results: ROC area of the EuroSCORE II was between 0.73 and 0.80 for all types of surgery, being the lowest value for coronary surgery. The observed and expected mortality was 4.3% and 3.0%, respectively (p = 0.034). The decision curve analysis showed a positive net benefit for all thresholds below 0.24, considering all type of surgeries. Conclusion: The EuroSCORE II showed an adequate performance in terms of discrimination and calibration for all types of surgery, although somewhat inferior for coronary surgery. Though in general terms this model underestimated the risk in intermediate risk groups, its overall performance was acceptable. The EuroSCORE II could be considered an optional updated generic model of operative risk stratification to predict in-hospital mortality after cardiac surgery in our context.

Reducción del Riesgo en Equipos Biomédicos y en Instalaciones Eléctricas de Entornos Clínicos / Risk Reduction in Electrical Networks and Safety of Biomedical Equipment in Clinical Settings

Resumen Se analizan 112 auditorías de instalaciones eléctricas y seguridad de equipos biomédicos en 78 Institutos de Medicina Altamente Especializada (IMAE) del Uruguay, realizadas a lo largo de 14 años, clasificando el nivel de riesgo y de cumplimiento de normas desde el punto de vista de Ingeniería Clínica. Cada visita incluye una encuesta al personal encargado de mantener y gestionar la infraestructura eléctrica y el equipamiento biomédico, que abarca el estado de mantenimiento, el control y la documentación de las instalaciones eléctricas y del equipamiento biomédico. Se evalúa el riesgo con un puntaje de 0 a 4. En 2004-2007 el 74% de los IMAE tenía irregularidades en la instalación eléctrica, gestión de equipamiento, control de calidad o documentación. Además, un 15% de los que tenían problemas, tenía en particular equipamiento indicado como "equipo peligroso". En los períodos siguientes esta proporción baja paulatinamente hasta 0% en 2016-2017. No obstante, continúa existiendo un déficit en la gestión del equipamiento y en la documentación formal. El aporte de la Universidad en el seguimiento técnico de los IMAE se ha materializado en una mejora en materia de seguridad.

Abstract 112 field inspections to 78 high technology medical centers (IMAE is the Spanish acronym) over 14 years are analyzed. All visits were evaluated as to Clinical Engineering good practices and were assigned a risk level. All audits included a questionaire to maintenance management personnel on electrical network operation as well as on biomedical equipment follow-up and documentation from acquisition to disposal. Risk is assigned a level 0 to 4 at each visit. In 2004-2007, 74% of IMAEs had safety problems in one or more of electrical network, maintenance management or documentation, and 15% of the IMAEs with safety problems had one piece of equipment described as simply "dangerous". Electrical safety problems were eventually reduced to 0% in 2016-2017, probably as a consequence of regular audit and counseling by this University Clinical Engineering Program.

Acute and chronic toxicity of pesticides on tadpoles of Physalaemus cuvieri (Anura, Leptodactylidae).

Brazil is the largest consumer of pesticides in the world. However, knowledge on how these pesticides affect wildlife is scarce. Among the vertebrates, amphibians are particularly important in research to assess the impact of pesticides because of the correlation between pesticide and the decline of these species. This study aimed to evaluate the acute and chronic toxicity of commercial formulations of pesticides, i.e., atrazine (herbicide), cypermethrin (insecticide), and tebuconazole (fungicide) in Physalaemus cuvieri tadpoles. Eggs were collected in nature and cultivated under controlled conditions in the laboratory. Toxicity tests were carried out under standard conditions to determine the lethal concentration (LC50) after 96 h of exposure and to determine the effect of sublethal concentrations after 7 days. In addition, we performed swimming activity tests on tadpoles exposed to sublethal concentrations. The lethal concentration (LC50) was 19.69 mg/L for atrazine, 0.24 mg/L for cypermethrin and 0.98 mg/L for tebuconazole. In the acute test, atrazine showed lower toxicity than cypermethrin and tebuconazole for P. cuvieri. Swimming activity was affected at sublethal doses of atrazine and cypermethrin, but was not after exposure to tebuconazole. Cypermethrin was the insecticide that most altered the swimming activity of the individuals tested. The risk evaluation analysis indicated risks for tadpoles exposed to three tested pesticides, specially cypermethrin.

In vitro safety and efficacy evaluations of a complex botanical mixture of Eugenia dysenterica DC. (Myrtaceae): Prospects for developing a new dermocosmetic product.

In the context of developing a new natural product-based cosmetic, the in vitro efficacy and safety evaluations of a complex botanical mixture based on Eugenia dysenterica leaf hydroalcoholic extract (EDE) (2.5-1000µg/mL) were carried out. Chromatographic analysis demonstrated the presence of the tannin (ellagic acid) and flavonoids (quercetin and gallic acid) which characterize the EDE as a polyphenol-rich mixture. Using HFF-1 fibroblasts, it was shown that EDE promoted cell regeneration after UVA exposure. It also led to the inhibition of the collagenase, elastase and tyrosinase enzymes, which are involved in skin-related disorders. In terms of toxicological evaluation, the EDE was classified as non-phototoxic through the 3T3 Neutral Red Uptake Phototoxicity Test (OECD N° 432, 2004) and non-eye irritant by Bovine Corneal Opacity and Permeability (OECD N° 437, 2013) assay, in conjunction with corneal histomorphometric analysis. Furthermore, the EDE has no skin sensitization potential as demonstrated by a two-out-of-three prediction model [protein-binding/haptenization (OECD N° 442C, 2015), keratinocyte and dendritic cell activations]. In addition, it was shown that the EDE seems to be non-genotoxic through the cytokinesis-block micronucleus assay (OECD N° 487, 2014) using HepG2 cells. When considered together, these findings support the use of EDE botanical mixture in cosmetic/pharmaceutical products.

FES Bike Race preparation to Cybathlon 2016 by EMA team: a short case report.

FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FES-cycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race's first lap.

Prospective validation of EuroSCORE II in patients undergoing cardiac surgery in Argentinean centres.

OBJECTIVES: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is an updated version of the original EuroSCORE that must be extensively validated. The objective was to prospectively evaluate the efficacy of EuroSCORE II in predicting the immediate results of cardiac surgery in Argentinean centres. METHODS: A prospective consecutive series of 503 adults who underwent cardiac surgery between January 2012 and April 2013 was studied. EuroSCORE II discrimination and accuracy were assessed in the overall cohort and in two surgically defined subgroups: isolated coronary artery bypass graft (CABG) surgery and non-CABG surgery. Additionally, a risk-adjusted cumulative sum control chart analysis was performed. RESULTS: In-hospital overall mortality rate was 4.17%, while the mortality rate predicted by the EuroSCORE II was 3.18% (P = 0.402). Receiver operating characteristic curve analysis demonstrated a good overall (area 0.856) and non-CABG subgroup (area 0.857) discrimination (P = 0.0001), while discrimination in the CABG subgroup was poorer (area 0.794, P = 0.014). The model showed good calibration in predicting in-hospital mortality, both overall (Hosmer-Lemeshow, P = 0.082) and for each subgroup (non-CABG, P = 0.308, and CABG, P = 0.150). CONCLUSIONS: EuroSCORE II reflects a better current surgical performance and offers a new quality standard to evaluate local outcomes. EuroSCORE showed an overall good discriminative capacity and calibration in this local population; nevertheless, the model performed optimally in non-CABG surgery and in highest-risk patients, underestimating in-hospital mortality in lowest-risk cases. The latter finding may be interpreted as an inadequate behaviour of the model, as a poor performance of surgeons or both. Larger prospective studies will elucidate this hypothesis.

Root causes, clinical effects, and outcomes of unintentional exposures to buprenorphine by young children.

OBJECTIVE: To characterize the rates, root causes, and clinical effects of unintentional exposures to buprenorphine sublingual formulations among young children and to determine whether exposure characteristics differ between formulations. STUDY DESIGN: Unintentional exposures to buprenorphine-containing products among children 28 days to less than 6 years old were collected from the Researched Abuse, Diversion, and Addiction-Related Surveillance System Poison Center Program and Reckitt Benckiser Pharmaceuticals' pharmacovigilance system from October 2009-March 2012. After adjustment for drug availability, negative binomial regression was used to estimate average exposure rates. Root cause assessment was conducted, and an expert clinician panel adjudicated causality and severity of moderate to severe adverse events (AEs). RESULTS: A total of 2380 cases were reviewed, including 4 deaths. Exposures to buprenorphine-naloxone combination film were significantly less frequent than exposures to buprenorphine tablets (rate ratio 3.5 [95% CI, 2.7-4.5]) and buprenorphine-naloxone combination tablets (rate ratio 8.8 [7.2-10.6]). The most commonly identified root causes were medication stored in sight, accessed from a bag or purse, and not stored in the original packaging. Among 536 panel review cases, the most common AEs reported for all formulations were lethargy, respiratory depression, miosis, and vomiting. The highest level AE severity did not differ significantly by formulation. CONCLUSIONS: Unintentional exposure to buprenorphine can cause central nervous system depression, respiratory depression, and death in young children. Exposure rates to film formulations are significantly less than to tablet formulations. Package and storage deficiencies contribute to unintentional exposures in young children.

Potential invasive non-native fish farmed in the coastal region of Rio Grande do Sul, Brazil / Potencial invasor dos peixes não nativos cultivados na região costeira do Rio Grande do Sul, Brasil

Freshwater fish aquaculture in Brazil is based in a few species, mostly introduced from other countries or continents. When an exotic species is introduced into the ecosystem, there are a risk that this specie will escape in a natural system, resulting in a possible detrimental effects to native species or even to the ecosystem functioning. In order to provide the public managers decisions about which species should be ecologically suitable for use in aquaculture in the coastal region of the Rio Grande do Sul State, this study classifies the invasive potential of several fish species used in inland aquaculture in the region. The list of species cultivated in the region was obtained by a literature review and consultation of agricultural extension agencies or institutions that provides technical assistance and serve as intermediaries in the purchase of fingerlings. The protocol Fish Invasiveness Screening Kit - FISK was applied to classify non-native species according to invasive potential. Ten non-native species are cultivated in the region. Ctenopharyngodon idella, Cyprinus carpio, Hypophthalmichthys molitrix, H. nobilis, Ictalurus punctatus and Oreochromis niloticus presented a high invasive potential, scoring between 22 and 38, while Pseudoplatystoma fasciatum, P. corruscans, Piaractus mesopotamicus and Hoplias lacerdae presented medium invasive potential, scoring between 9 and 15. The species with high potential should compose a "black" list and have to be prohibited its use. For the specieswith medium invasive potential further studies should be applied in order to determine the danger or not of its use in aquaculture in the region of Patos Lagoon.

No Brasil, o cultivo de peixes de água doce é baseado em poucas espécies, a maioria, introduzida de outros países ou continentes. Quando uma espécie é introduzida no ecossistema existe o risco de ela escapar para o ambiente natural, resultando em possíveis efeitos prejudiciais à biota nativa ou até mesmo ao funcionamento do ecossistema. A fim de fundamentar as decisões dos gestores públicos sobre quais espécies seriam adequadas ao uso em aquicultura na região costeira do RS, este estudo classificou o potencial invasor das espécies não nativas de peixes cultivadas na região. A lista de espécies presentes nos cultivos foi obtida por meio de pesquisa bibliográfica e consulta a órgãos de extensão agropecuária ou instituições que prestam assistência técnica ou que atuam como intermediários na aquisição de alevinos. O protocolo Fish Invasiveness Screening Kit FISK foi aplicado para classificar as espécies não nativas de acordo com o seu potencial invasor. Dez espécies não nativas são cultivadas na região. Ctenopharyngodon idella, Cyprinus carpio, Hypophthalmichthys molitrix, H. nobilis, Ictalurus punctatus e Oreochromis niloticus apresentaram alto potencial invasor (pontuação entre 22 e 38), enquanto Pseudoplatystoma fasciatum, P. corruscans, Piaractus mesopotamicus e Hoplias lacerdae apresentaram médio potencial invasor (pontuação entre 9 e 15). As espécies com alto potencial invasor devem comporuma lista "negra" e terem seu uso proibido. Para as espécies com médio potencial invasor devem ser aplicados estudos complementares para determinar a proibição ou não de seu uso na aquicultura da região da Lagoa dos Patos.

Series paralelas al Rorschach: validación en nuestro medio de la serie de Parisi-Pes y del Test de Zulliger / Rorschach parallel series: local validation of the Parisi-Pes series and the Z Test

El presente artículo surge de la necesidad de validar, en nuestro medio, series paralelas al Test de Rorschach con el fin de poder reemplazarlo en aquellos casos en que se lo requiera. El incremento de la difusión de esta técnica, fuera del ámbito de la comunidad psicológica, puede derivar en un efecto de aprendizaje que dificulte el uso de la herramienta psicodiagnóstica. En esta publicación se realiza un recorrido a través de las diferentes series propuestas como paralelas al Test de Rorschach y se exponen los resultados de dos investigaciones: una de las cuales corresponde a la serie de Parisi-Pes, creada por la Escuela Romana de Rorschach, poco difundida en nuestro medio pero validada en uno con características socioculturales similares al nuestro (Proyecto UBACyT P039); y la otra, el Test de Zulliger, que se aplica con frecuencia en el ámbito laboral, en ambas versiones, individual y colectiva (Proyecto UBACyT P005).

This article stems from the need to validate Rorschach parallel series at our social environment, in order to replace it when required. The increase in the dissemination of this technique, outside the psychological community, can lead to a learning effect which may prevent this psychodiagnostic tool from being used. This publication is a journey through the different Rorschach parallel series, and the results from two previous researches are being exposed: the first one of those, belongs to the Parisi-Pes series, created by the Roman Rorschach School, not much locally known but it had been validated in a similar social environment (Project UBACyT P039); the other one, the Z Test, is often used at Labor Psychology in both versions, individual and group administrations (Project UBACyT P005).

Residuos de plaguicidas organoclorados en leches infantiles y productos lácteos y su evaluación del riesgo / Risk assessment of organochlorine pesticides residues in infant milks and milk products

Se considera que la población infantil es el grupo mas sensible a los contaminantes provenientes de la ingesta de alimentos y debido a la alta relación consumo/ peso corporal. En vista de la problemática mundial de la contaminación ambiental por plaguicidas en Argentina no existe hasta el momento información sobre ingestas deplaguicidas y evaluación del riesgo en este grupo. Los alimentos infantiles (leches y productos lácteos) cubren una parte importante de los requerimientos nutricionales diarios para esta población pero al mismo tiempo puede contribuir con la exposición a contaminantes.El presente trabajo fue realizado a fin de investigar plaguicidas en alimentos especialmente desarrollados y recomendados para neonatos y niños. Se analizaron residuos de plaguicidas organoclorados en 50 muestras de leches maternizadas y en 51 muestrasde productos lácteos (postres y yugures) recogidas en el mercado local de Buenos Aires durante el período febrero de 2001 a diciembre de 2003. La investigación fue realizada mediante cromatografía gaseosa con detector de captura de electrones e inyección automática. Los resultados fueron expresados en ng/mL y se consideraron los siguientes grupos: €Aldrinas;€Clordano; €DDT; €Endosulfán; €HCH; €Heptacloro; Endrin; HCB y Lindano. Con los resultados obtenidos se calculó la Ingesta Diaria Estimada (IDE) en base al consumo de alimentos lácteos y el peso corporal. Los resultados fueron comparados con las IDAs recomendadas por el Codex Alimentarius. De las 101 muestras analizadas el 10 % no contiene ninguno de los plaguicidas investigados, 24,8% contiene al menos un pesticida, 19,7% contiene dos y el 2 % mostró evidencia de siete u ocho plaguicidas organoclorados de los diferentes grupos. De todos los grupos de pesticidas investigados las €Aldrinas y €DDT tuvieron porcentajes representativos (32%), y el€Heptachlor y €HCH las frecuencias mas elevadas, (57%) y (53%) respectivamente...

Children population is considered the most sensitive group to contaminants by food intake due to the high ratio food consumption/ body weight. Despite the worldwide problematic of pesticides environmental pollution in Argentine untilthis moment does not exist data about pesticide intake and risk assessment in this group. Baby food (milk and milk products) cover an important part of the daily nutritional requirements of this population but as the same time could contribute with the exposure to contaminants. The present work was aimed to investigate pesticides in products specially manufactured and recommended for neonates andinfants. Organochlorine pesticides residues were assessed on 50 milk samples and 51 milk products colleted at different local markets at Buenos Aires, between February 2001 and December 2003. The pesticides determination was performed by gas chromatography electron capture detection. The results were expressed in ng/mL and it was considered the following groups:€Aldrins; €Chlordane; €DDT; €Endosulfan; €HCH; €Heptachlor; Endrin; HCB and Lindane. With the result obtained the Estimate Daily Intake (EDI) was calculated on the basis of the daily consumption and the average body weight. The result obtained wascompared with the Acceptable Dialy Intake (ADI) recommended by the Codex Alimentarius. Among 101 samples analyzed, 10% did not contain pesticides residues, 24.8% contained at least one pesticide, 19.7% containedtwo and 2% showed evidence of seven and eight organochlorine pesticides. Among all pesticides groups investigated€Aldrins and €DDT had representative percentages (32%), and €Heptachlor (57%) and €HCH (53%) were the highest frequency groups...