A novel disposable sensor for measure intra-abdominal pressure.

BACKGROUND: Measurement of intra-abdominal pressure (IAP) is realized with the Kron's method. However, this technique has drawbacks like an infusion of water into the bladder of the patient. OBJECTIVE: The prove a new novel disposable sensor in the way to measure the IAP (DSIAP) this one addresses some limitations of the Kron method. MATERIALS AND METHODS: The DSIAP was tested in vitro and clinical settings. The proposed technique was compared with Kron's method through Pearson correlation and Bland-Altman analysis. For in vitro tests, 159 measurements were taken performed by simulating the IAP in the bladder. For the clinical test, 20 pairs of measurements were made in patients with routine IAP monitoring in the intensive care unit. RESULTS: In vitro measurements showed a strong correlation between the DSIAP and the reference (r = 0.99, p-value < 2.2 × 10-16). The bias and 95% confidence intervals were 0.135 and -0.821-1.091 cmH2O, respectively. Measurements in patients with DSIAP versus Kron's method shown a very good correlation (r = 0.973, p-value < 5.46 × 10-13), while the bias and confidence intervals were 0.018 and -3.461-3.496 mmHg, respectively. CONCLUSIONS: The results suggest that the proposed DSIAP showed a profile similar to pressure transducers already in clinical use while overcoming some limitations of the former.

ANTECEDENTES: La medición de la presión intraabdominal (PIA) generalmente se realiza con el método de Kron, a pesar de presentar inconvenientes como la infusión de agua en la vejiga del paciente. OBJETIVO: Introducir un nuevo sensor desechable para medir la PIA (SDPIA) que aborda algunas limitaciones del método de Kron. MÉTODO: Se probó el SDPIA en pruebas in vitro y clínicas. La técnica se contrastó con el método de Kron empleando la correlación de Pearson y el análisis de Bland-Altman. Para las pruebas in vitro se realizaron 159 mediciones simulando la PIA en la vejiga. Para las pruebas clínicas se realizaron 20 mediciones en pacientes con monitorización rutinaria de la PIA en la unidad de cuidados intensivos. RESULTADOS: En las mediciones in vitro se encontró una alta correlación (r = 0.99; p < 2.2 × 10−16). El sesgo para la diferencia entre los dos métodos de medición fue de 0.135 cmH2O, con un intervalo de confianza del 95% de −0.821 a 1.091 cmH2O. En las mediciones clínicas también se encontró una alta correlación (r = 0.973; p < 5.46 × 10−13) para la diferencia entre los dos métodos de medición de 0.18, con un intervalo de confianza del 95% de −3.302 a 3.650 mmHg. CONCLUSIONES: Los resultados sugieren que el SDPIA propuesto muestra un desempeño similar al de los transductores de presión actualmente en uso clínico, mientras sobrelleva algunas limitaciones de estos últimos.

Surveillance system for acute severe infections with epidemic potential based on a deterministic-stochastic model, the StochCum Method.

BACKGROUND: The dynamic interactions of severe infectious diseases with epidemic potential and their hosts are complex. Therefore, it remains uncertain if a sporadic zoonosis restricted to a certain area will become a global pandemic or something in between. OBJECTIVE: The objective of the study was to present a surveillance system for acute severe infections with epidemic potential based on a deterministic-stochastic model, the StochCum Method. DESIGN: The StochCum Method is founded on clinical, administrative, and sociodemographic variables that provide a space/time map as a preventive warning of possible outbreaks of severe infections that can be complemented based on the sum of all the first accumulated cases. If the outbreak is happening in high-risk areas, an early warning can be elicited to activate the health response system and save time while waiting for the confirmation of symptomatic cases. RESULTS: The surveillance system was tested virtually for 1 month on admissions to the emergency room of a public hospital located in Mexico City, Mexico. It promptly identified simulated cases of acute respiratory infections with epidemic potential. CONCLUSIONS: The StochCum Method proved to be a practical and useful system for conducting epidemic surveillance on a hospital network.

Electronic Devices That Identify Individuals with Fever in Crowded Places: A Prototype.

Most epidemiological surveillance systems for severe infections with epidemic potential are based on accumulated symptomatic cases in defined geographical areas. Eventually, all cases have to be clinically verified to confirm an outbreak. These patients will present high fever at the early stages of the disease. Here, we introduce a non-invasive low-cost electronic device (bracelet) that measures and reports 24/7, year-round information on the temperature, geographical location, and identification of the subject using the device. The data receiver can be installed in a tower (ground) or a drone (air) in densely populated or remote areas. The prototype was made with low-cost electronic components, and it was tested indoors and outdoors. The prototype shows efficient ground and air connectivity. This electronic device will allow health professionals to monitor the prevalence of fever in a geographical area and to reduce the time span between the presentation of the first cases of a potential outbreak and their medical evaluation by giving an early warning. Field tests of the device, programs, and technical diagrams of the prototype are available as Supplementary Materials.

[Reflections concerning the care process in the emergency medical services]. / Reflexiones sobre el proceso de atención en los servicios de urgencias.

In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services.

En el presente artículo se presentan algunas reflexiones sobre el proceso de atención en los servicios de urgencias médicas, así como algunos de los retos que enfrentan estos componentes fundamentales del sector salud de nuestro país. Se hace énfasis en el creciente volumen y la complejidad de los casos atendidos en estos servicios, lo cual contribuye a su saturación.

[Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation]. / Índice de Saturación Modificado y Ambulancias (ISMA): asignación de ambulancias y reservación remota de camas en los Servicios de Urgencias Médicas.

INTRODUCTION: In most places all over the world­including our country­services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. OBJECTIVE: To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. MATERIAL AND METHODS: The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. RESULTS: The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. CONCLUSIONS: This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

[Evaluation of policies in the procedures for food handling to prevent nosocomial infections in general hospitals and public institutions of health in Mexico]. / Evaluación de políticas en manejo de alimentos para prevenir infecciones nosocomiales en hospitales generales de instituciones públicas de salud en México.

OBJECTIVE: To evaluate the implementation and proper use of policies and procedures for food handling to prevent nosocomial gastrointestinal infections in major General Hospitals and Public Institutions of Health in Mexico. MATERIAL AND METHODS: We performed a cross-sectional study of food services in 54 second-level general hospitals from these institutions: Mexican Institute of Social Security (IMSS), Institute of Security and Social Services for State Workers (ISSSTE), and the Ministry of Health (SESA). A questionnaire was made to identify risk factors for food contamination. In the statistical analysis, we determined the relative frequency of food handling complying with the norm; a qualitative analysis was performed using an intentional non-probabilistic sampling, targeting department heads, managers, and operational staff. The qualitative variables were verified through non-parametric tests. RESULTS: From 54 hospitals evaluated, 81% had procedure and operation manuals, 35% prepared and stored food according to NOM-251-SSA1-2009, 52% performed ongoing training, 62% had a record of microbiological analysis done to staff and 81% done to foods, and 31% had first in first out (FIFO) temperature control systems. CONCLUSIONS: Second-level health institutions in Mexico have deficiencies in the implementation of norms and procedures to handle, store, and prepare food that can lead to gastrointestinal outbreaks of nosocomial infections in patients, health staff, and visitors. In order to ensure the quality of food preparation for distribution and consumption in hospitals, it is necessary that food services comply with current norms and regulations, updating policies and procedures, and training their staff continuously.

[An automated registry program for nosocomial infections]. / Programa de registro automatizado de infecciones nosocomiales.

Las infecciones nosocomiales presentan un gran reto para la medicina hospitalaria, en general, y para las Unidades de Cuidados Intensivos, en particular. Su elevada prevalencia, la gran morbilidad y mortalidad asociadas, el incremento de la estancia hospitalaria y, en consecuencia, los costos de la atención médica han hecho que los programas de vigilancia, control y prevención de infecciones nosocomiales sean una parte toral de los protocolos de seguridad para el paciente y un indicador de calidad de la atención médica.

[Modified overcrowd index in emergency room]. / Índice de saturación modificado en el servicio de urgencias médicas.

INTRODUCTION: Overcrowd of emergency rooms affects efficiency and quality of medical care. OBJECTIVES: To describe the mathematical-computational system modified overcrowd index which measures in real time and in four levels of warnings (non crowded, crowded, overcrowded and extreme overcrowded) emergency room saturation in a network of hospitals, from only seven simple variables (number of available beds, physicians and nurses, number of patients in the waiting room, in medical consultation and admitted for further evaluation, as well as number of critically ill patients admitted). MATERIALS AND METHODS: The modified overcrowd index was exhaustively tested with 245,280 virtual transactions from seven hospitals in an uninterrupted schedule basis simulating hourly surveillance for four years. RESULTS: From 224 episodes of overcrowd, 216 (97%) where correctly identified and verified by the network of hospitals warnings, its time series also provided useful information about available personnel and resource distribution within the hospital network. CONCLUSIONS: Modified overcrowd index is an efficient tool detecting emergency room overcrowd outbreaks in a network of hospitals.

[New device and technique to measure intra-abdominal pressure]. / Nueva técnica y dispositivo para medir la presión intraabdominal.

INTRODUCTION: sequential measurement of intra-abdominal pressure is of paramount importance for an early detection and appropriate therapeutic management of intra-abdominal hypertension and abdominal compartment syndrome. OBJECTIVE: to validate a device and technique developed to measure intra-abdominal pressure (an innovation of the Foley urinary catheter named intra-abdominal pressure catheter). METHODS: three different sets of measurements where done to test the intra-abdominal pressure catheter device: I. 50 measurements were done with the intra-abdominal pressure catheter device and compared against those measurements done using a manometer graded in cm H(2)O; II. Direct measurement of intra-abdominal pressure in five patients during elective laparoscopy vs the intraabdominal pressure catheter device; and III. Measurement of intra-abdominal pressure by the Kron method (Gold standard) vs intra-abdominal pressure catheter device in three patents with intra-abdominal hypertension/abdominal compartment syndrome. Measurements where compared with Pearson correlation test and Bland Altman statistics. RESULTS: I.Intra-abdominal pressure catheter vs graded manometer: r = 0.99, with a mean pressure difference of 0.27 ± 0.23 mmHg, CI (0.039 to 0.092 mmHg). II. Direct measurement of intra-abdominal pressure during laparoscopy vs intra-abdominal pressure catheter device: r = 0.93, with a mean pressure difference of 0.18 ± 0.84 mmHg, CI (-1.46 to 1.83 mmHg) and III. Measurement of intra-abdominal pressure by the Kron Method vs intra-abdominal pressure catheter device: r = 0.81, with a mean pressure difference of -0.41 ± 0.87, CI (-2.12 mmHg to 1.30 mmHg). CONCLUSIONS: the intra-abdominal pressure catheter device is a safe and reliable instrument for measuring intra-abdominal pressure.

[Survey about responsiveness of third-level hospitals to a medical disaster: after the pandemic influenza in Mexico]. / Encuesta sobre la capacidad de respuesta de los hospitales de alta especialidad ante un desastre médico: después de la influenza pandémica en México.

BACKGROUND: The recent pandemic influenza AH1N1 virus made it clear that planning for medical disaster response is critical. OBJECTIVE: To know the responsiveness of a sample of highly specialized hospitals in Mexico to a medical disaster, with the previous pandemic influenza AH1N1 as reference. METHODS: A survey was conducted among the Medical Directors of a sample of highly specialized hospitals, covering: previous experience with the pandemic influenza, space considerations, material resources, staff, logistics, and current general perspectives. Descriptive statistics were used for analysis. RESULTS: A 95% response was obtained from the institutions (19 hospitals). Of these, 47.4% considered that the medical institution was not ready to respond to pandemic influenza. The median surge capacity for the Intensive Care Unit beds was 30% (range 0 to 32 beds). The least reserve in medication was found in the antivirals (26.3%). Only 47.4% considered having enough intensive care nurses and 57.9% enough respiratory technicians; 42.1% would not have an easy access to resources in an emergency. CONCLUSIONS: Prevention is key in responsiveness to medical disasters, and therefore the basic steps for planning strategies must be considered.

Moonlighting peptides with emerging function.

Hunter-killer peptides combine two activities in a single polypeptide that work in an independent fashion like many other multi-functional, multi-domain proteins. We hypothesize that emergent functions may result from the combination of two or more activities in a single protein domain and that could be a mechanism selected in nature to form moonlighting proteins. We designed moonlighting peptides using the two mechanisms proposed to be involved in the evolution of such molecules (i.e., to mutate non-functional residues and the use of natively unfolded peptides). We observed that our moonlighting peptides exhibited two activities that together rendered a new function that induces cell death in yeast. Thus, we propose that moonlighting in proteins promotes emergent properties providing a further level of complexity in living organisms so far unappreciated.

An FPGA implementation to detect selective cationic antibacterial peptides.

Exhaustive prediction of physicochemical properties of peptide sequences is used in different areas of biological research. One example is the identification of selective cationic antibacterial peptides (SCAPs), which may be used in the treatment of different diseases. Due to the discrete nature of peptide sequences, the physicochemical properties calculation is considered a high-performance computing problem. A competitive solution for this class of problems is to embed algorithms into dedicated hardware. In the present work we present the adaptation, design and implementation of an algorithm for SCAPs prediction into a Field Programmable Gate Array (FPGA) platform. Four physicochemical properties codes useful in the identification of peptide sequences with potential selective antibacterial activity were implemented into an FPGA board. The speed-up gained in a single-copy implementation was up to 108 times compared with a single Intel processor cycle for cycle. The inherent scalability of our design allows for replication of this code into multiple FPGA cards and consequently improvements in speed are possible. Our results show the first embedded SCAPs prediction solution described and constitutes the grounds to efficiently perform the exhaustive analysis of the sequence-physicochemical properties relationship of peptides.