Impact of an influenza vaccine educational programme on healthcare personnel.

Influenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

[Nirsevimab effectiveness against hospital admission for respiratory syncytial virus bronchiolitis in infants]. / Efectividad de nirsevimab en la prevención de los ingresos por bronquiolitis por virus respiratorio sincitial en lactantes.

OBJECTIVE: Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. This season, a long half-life monoclonal antibody (Nirsevimab) is available to prevent this disease for all infants born from 1 April-30 September to 2023 and all those born during RSV season (October2023- March 2024). The aim of this study was to evaluate the impact of the implementation of this antibody on RSV admissions in a tertiary hospital. METHODS: Observational, retrospective and analytical study. All patients <6 months in October admitted for bronchiolitis at 2 time points were included: T1 or Pre-nirsevimab time: 1 September 2015-30 September 2023 and T2 or Nirsevimab time: 1 October-31 December 2023. Total admissions due to any cause of infants <6 months in the same period were used as the reference population. To assess the impact of the implementation of nirsevimab, we calculated the reduction in the percentage of admissions due to RSV with respect to total admissions in both periods, and also in the 2023-2024 season we calculated the double negative test to calculate the effectiveness of the intervention (1-Odds ratio) x 100. RESULTS: In infants under 6 months of age, we found significant differences in the number of admissions for RSV bronchiolitis between the last season and the previous 7 seasons [574/1195 (48%) vs 6/138 (4.3%); p<0.01, RPI: 91%). In the 2023/2024 season, the effectiveness of nirsevimab in preventing admission for RSV bronchiolitis in children under 6 months of age was 85% (CI 95%: 32-97%). CONCLUSIONS: The implementation of nirsevimab has had an important impact on the number of hospital admissions for RSV bronchiolitis. There were no differences in the severity of bronchiolitis.

[Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. / Impacto de los «daily huddle¼ en la seguridad del paciente pediátrico hospitalizado.

INTRODUCTION: In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS: Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS: Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS: Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

Pericapsular nerve group block in hip surgery. An alternative that goes beyond what we know?

Hip fracture is a pathology usually observed in older patients, prone to complications and increased morbidity and mortality during hospital admission. The PENG (Pericapsular Nerve Group) block has recently been described to provide higher quality analgesia, favoring early ambulation. The literature search was carried out from November 2018 to July 2021 with the following keywords: pericapsular nerve group block and PENG block. Studies conducted in the pediatric population or in adults with an indication other than hip surgery were excluded; obtaining 18 articles to read in full text. The analyzed studies had positive results in favor of performing the PENG block in hip surgery. Unfortunately, the current evidence is insufficient to be able to integrate the results obtained and draw conclusions about the effectiveness and safety of the PENG block.

Cerebral oximetry monitoring in the management of severe hypoxaemia associated with transposition of the great arteries with balloon atrial septostomy. / Monitorización de la oximetría cerebral en el manejo de la hipoxemia severa asociada a la transposición de grandes arterias mediante atrioseptostomía con balón.

Transposition of the great arteries (D-TGA) is one of the most common congenital heart diseases requiring neonatal surgical intervention. In the desperately ill neonate with TGA and the resultant hypoxaemia, acidemia, and congestive heart failure, improvement is often obtained with balloon atrial septostomy (BAS). Current methods employed to evaluate oxygen delivery and tissue consumption are frequently nonspecific. Near infrared spectroscopy (NIRS) allows a continuous non-invasive measurement of tissue oxygenation which reflects perfusion status in real time. Because little is known about the direct effect of BAS on the neonatal brain and on cerebral oxygenation, we measured the effectiveness of BAS in two patients with D-TGA using NIRS before and after BAS. We concluded BAS improves cerebral oxygen saturation in neonates with D-TGA.

An assay on the effect of preliminary restoration tasks applied to a large TENORM wastes disposal in the south-west of Spain.

A large industrial wastes disposal site, where two phosphate rock processing plants release their wastes, located close to Huelva town (SW of Spain), has been partially submitted to restoration as a preliminary step in a possible decomissioning process. Due to the high natural radioactivity contents of these wastes, this repository is considered as a radiological anomaly, being actually considered as TENORM (technically enhanced naturally occurring radioactive materials). The efficiency of this restoration from the radiological point of view according to the new European regulatory framework was evaluated in this work. The results allow to conclude that, as a consequence of the partial restoration works, the external dose rate has been drastically reduced above the repository system. Nevertheless, special attention must be paid on the occupational factor to be applied to workers on the unrestored system. The application of a dosimetric model allows the prediction of the negative effects of using certain industrial wastes as a cover system in this restoration/mitigation task.

[Control of epilepsy in children and adolescents suffering from cerebral palsy, with respect to their etiology and cerebral lesion background]. / Control de la epilepsia en niños y adolescentes con parálisis cerebral con respecto a la etiología y la lesión cerebral de base.

INTRODUCTION: Epilepsy in children with cerebral palsy is a very important problem of public health, with a prevalence 750/1,000. AIM. To describe the relationship between cerebral palsy-etiologies and the cerebral injuries in the epilepsy control. PATIENTS AND METHODS: Retrospective study included 398 subjects, both genders, subjects under 18 years old with evidence of epilepsy related to infantile cerebral palsy (ICP). For comparison analysis purposes the entire population was studied on two principally aspects: ICP based on its etiology, and ICP based on cerebral injury background by means of computer tomography (CT). The etiology was subdivided into: hypoxic-ischemic encephalopathy (HIE), cerebral malformation (CM), and others causes (O). Cerebral lesions were classified into: diffuse cerebral injury (DCI), focal location injury (FLI), basal ganglia injury (BGI), cerebral dysgenesia (CD), hydrocephaly (H) and non-CT evidence (N). The impact of the epileptic seizures was determined according to the cerebral injury background and its etiology. RESULTS: The findings after clinical surveillance and statistical analysis were able to affirm that seizures control with respect to etiology was: HIE: 77.9%, CM: 72%, O: 86% without statistical significance (p < 0.28). We found in the cerebral lesion: DCI: 70.7 %, FLI: 82.4%, BGI: 87.5%, CD: 79.3%, H: 77.8%, N: 83.3%, statistical significance was found in these subgroups (p < 0.04). CONCLUSION: Cerebral injury in children suffering from cerebral has a prognostic reliance value in the control of epilepsy, regardless its etiology.

Toxina botulínica en el tratamiento del síndrome de dolor miofascial / Botulinum toxin in the treatment of myofascial pain syndrome

Las infiltraciones con toxina botulínica han sido utilizadas en el tratamiento del dolor asociado a múltiples patologías, como distonías focales, espasticidad, cefaleas y dolor miofascial. Sin embargo, los resultados de los diferentes estudios realizados con toxina botulínica en el síndrome de dolor miofascial (SDM) son contradictorios. El objetivo de la presente revisión es analizar la evidencia de la eficacia de la toxina botulínica tipo A (TBA) frente a placebo en la disminución del dolor crónico de origen miofascial.Se realizó una búsqueda bibliográfica en PubMed, Web of Science (WoS), Scielo y Scopus, utilizando las siguientes palabras clave: dolor miofascial, punto gatillo, toxina botulínica y bótox. Los estudios que cumplieron los criterios inclusión fueron once ensayos clínicos que comparaban la TBA frente a solución salina normal (SSN).Aunque en la mayoría de los ensayos clínicos ana­lizados no podemos evidenciar un beneficio de la TBA frente a SSN, no sería acertado concluir que la toxina botulínica no está indicada en el tratamiento de dolor asociado al SDM, dado que existe una selección de pacien­tes muy heterogénea, hay una gran variabilidad en la dosis de toxina botulínica, se usan diferentes técnicas de infiltración de los puntos gatillo (PG), la duración de los estudios es variable y no hay estudios que realicen un análisis costo-efectivo.Se necesitan ensayos clínicos más específicos, con muestras más homogéneas, que nos permitan sacar conclusiones acerca del papel de la TBA en el tratamiento del SDM.(AU)

Botulinum toxin injections have been used in pain treatment associated with pathologies such as focal dystonia, spasticity, headaches and myofascial pain. However, results from botulinum toxin trials in myofascial pain syndrome (MPS) are contradictory.The objective of this paper is to analyze the evidence of botulinum toxin type A (BTA) efficacy compared to placebo in myofascial pain management. Literature search was performed in PubMed, Web of Science (WoS), Scielo and Scopus, using the following key words: myofascial pain, trigger point, botulinum toxin and botox. Eleven clinical trials comparing BTA versus normal saline solution (NSS) met the inclusion criteria. Although most of the clinical trials analyzed cannot demonstrate a BTA superiority, it would not be correct to conclude that botulinum toxin is not indicated in miofascial pain treatment due to the great heterogeneous patient selection, variability in BTA doses, different trigger points (TP) injections techniques, variability in trials duration, and absence of cost-effective analysis.More specific clinical trials are required using homogeneous samples to provide conclusive evidence for BTA in the MPS treatment.(AU)

Exploitation of pollen by mycorrhizal mycelial systems with special reference to nutrient recycling in boreal forests.

Very large quantities of pollen are released annually by wind-pollinated trees, which dominate northern forest ecosystems. Since pollen is enriched in both nitrogen and phosphorus, this recurrent pulse of deposition constitutes a significant potential source of these elements in what are known to be severely nutrient-limited systems. Here, we demonstrate for the first time, to our knowledge, that an ectomycorrhizal fungus, Paxillus involutus, is able to scavenge effectively for nitrogen and phosphorus in pollen and to return a significant proportion of each nutrient to its autotrophic host, Betula pendula. More than 75 and 96%, respectively, of the nitrogen and phosphorus were removed from pollen in microcosms containing the mycorrhizal fungus, 29 and 25%, respectively, being transferred to the plants. In contrast, in microcosms without the mycorrhizal fungus only 42 and 35%, respectively, of nitrogen and phosphorus were lost from the pollen, presumably as a result of export by saprotrophs, and only 12 and 7%, respectively, were transferred to the plants. We hypothesize that this process of resource recapture, by contributing significantly to the ability of the trees to sustain the necessary annual investment in pollen production, will have a major impact upon their reproductive capabilities and hence 'fitness'.

Mycorrhizas and nutrient cycling in ecosystems - a journey towards relevance?

Progress towards understanding the extent to which mycorrhizal fungi are involved in the mobilization of nitrogen (N) and phosphorus (P) from natural substrates is reviewed here. While mycorrhiza research has emphasized the role of the symbiosis in facilitation of capture of these nutrients in ionic form, attention has shifted since the mid-1980s to analysing the mycorrhizal fungal abilities to release N and P from the detrital materials of microbial faunal and plant origins, which are the primary sources of these elements in terrestrial ecosystems. Ericoid, and some ectomycorrhizal fungi have the potential to be directly involved in attack both on structural polymers, which may render nutrients inaccessible, and in mobilization of N and P from the organic polymers in which they are sequestered. The advantages to the plant of achieving intervention in the microbial mobilization-immobilization cycles are stressed. While the new approaches may initially lack the precision achieved in studies of readily characterized ionic forms of N and P, they do provide insights of greater ecological relevance. The results support the hypothesis that selection has favoured ericoid and ectomycorrhizal systems with well developed saprotrophic capabilities in those ecosystems characterized by retention of N and P as organic complexes in the soil. The need for further investigation of the abilities of arbuscular mycorrhizal fungi to intervene in nutrient mobilization processes is stressed.

Validation of isotope signatures in sediments affected by anthropogenic inputs from uranium series radionuclides.

This paper aims to show the usefulness of 226Ra/228Ra activity ratios and confirm the possibility of using 230Th/232Th activity ratios as chronological markers in sediment cores from an estuarine system strongly contaminated by discharges from non-nuclear industries (fertiliser plants). The validation was carried out using an independent, well-established dating technique based on the analysis of the 137Cs fallout profile, which comprises the same time interval as that covered by both isotope ratios. The advantage of using the 226Ra/228Ra activity ratio profile instead of the Th-isotope profile is that determination can be accomplished with a non-destructive, simpler and less time-consuming technique, because both Ra isotopes can be determined by gamma-ray spectrometry.

A semi-empirical approach for determination of low-energy gamma-emmiters in sediment samples with coaxial Ge-detectors.

A simple method for the determination in sediment samples of low-energy gamma-emitters with coaxial Ge detectors and using a cylindrical sample geometry is outlined. This method allows an easy estimation of self-absorption effects by knowing the apparent densities and the composition of the investigated samples. As calibration matrixes solid samples enriched in known amounts of natural radionuclides emitting low-energy gamma rays were used. In this way, the difficult homogenisation steps needed when liquid spikes are added to a solid blank for manufacturing the calibration sample are avoided. The method has been carefully checked and validated by applying it to sediment samples with known activities of some low-energy gamma-ray emitters. Additionally, these sediment measurements have allowed to evaluate the magnitude and importance of the self-absorption corrections.

[Acquired immunodeficiency syndrome in the province of Cádiz. A study of 269 consecutive patients]. / El síndrome de inmunodeficiencia adquirida en la provincia de Cádiz. Estudio sobre 269 pacientes consecutivos.

BACKGROUND: The epidemiological characteristics, clinical manifestations and survival were analyzed in 269 patients with acquired immunodeficiency syndrome (AIDS) diagnosed in the province of Cadiz up to June 1970. METHODS: A multicenter protocol study including the 7 hospitals attending practically all of the population of the area of Cadiz was carried out. The diagnosis of AIDS was performed according to the 1987 CDC criteria. The Kaplan and Meier actuarial method was used for the survival study. RESULTS: The prevalence was of 10 cases in 1986, 37 in 1987, 61 in 1988, 121 in 1989 and 40 during the first 5 months of 1990. Males dominated (84%) and mean age was of 28.6 years. The predominant risk factor was parenteral drug abuse (84%) with signs of social unacceptance (unemployment 70% and with prison records 68%). Thirty eight percent of the patients were no longer drug addicts at the time of diagnosis. The number of cases of women who acquired the disease through heterosexual transmission has increased over the last 2 years (13 cases). Opportunistic infections made up 93% of the diagnostic criteria with esophageal candidiasis (EC) (45%) and extrapulmonary tuberculosis (ET) (34%) being the most frequent. The probability of survival was 14% at 35 months. When ET was the exclusive diagnostic criteria, survival was higher (30% vs 9%) and the mean of T4 lymphocytes in this group was higher (228 vs 154), all being statistically significant. CONCLUSIONS: AIDS is a serious, progressive problem of the Public Health Department in the province of Cadiz and predominantly affects parenteral drug addicts with a percentage higher than other Spanish series in socially unaccepted people. The increase in the cases of women with AIDS from heterosexual transmission is worrisome. EC and ET are the most verified diagnostic criteria. The prognosis of AIDS remains bad at short term, with survival being greater in those patients with ET as the exclusive criteria due to lesser cellular immunodeficiency.

[Infective endocarditis in heroin addicts in the province of Cádiz. A multicenter study of 150 cases]. / Endocarditis infecciosa en heroinómanos en la provincia de Cádiz. Un estudio multicéntrico sobre 150 episodios.

BACKGROUND: Given the progressive increase in infectious endocarditis (IE) in intravenous drug addicts (IVDA) in the province of Cadiz the present study was designed with the aim of studying the epidemiologic and clinical characteristics of this disease in our environment. METHODS: One hundred fifty episodes of IE occurring in 133 IVDA admitted to 6 hospitals in the province of Cadiz were studied in an open, multicentric study with a protocol of gathering of common data. Well known diagnostic criteria were used for this process and a univariant technique was employed in the analysis of prognostic factors. RESULTS: Fifty-three percent of the episodes occurred in the county of Campo de Gibraltar and 32% in the area of the Bay of Cadiz. The increase of the disease has been progressive since 1984 and marked over the last two years. All the patients presented fever, abnormal chest radiography in 90% and the process was produced by Staphylococcus aureus in 88%. Echography was abnormal in 85% of the episodes and vegetation was identified in 75%. The IE was located as right in 90%, mixed in 5% and left in 5%. Surgical treatment was required in 4 patients. Mortality was of 9%. Mixed or left location (p = 0.00003) and the development of the respiratory distress syndrome of the adult (p = 0.00001) were significantly associated with greater mortality. CONCLUSIONS: Infectious endocarditis in intravenous drug addicts maintains a well defined pattern of clinical expressivity and presents identifiable factors of prognostic influence. The increase in its prevalence in the province of Cadiz is probably due to a parallel increase in the addiction to intravenous heroin in this area.

[Cholestatic hepatitis caused by midecamycin]. / Hepatitis colestásica por midecamicina.

Hepatotoxicity by macrolide antibiotics, particularly erythromycin and derivatives, is a side effect extensively described in the literature. Midecamycin is a semi-synthetic derivative of this family with a wide safety margin of which isolated references of possible secondary hepatobiliary effects have been referred. The present clinical observation describes a case of cholestatic hepatitis which, in our opinion, was related to the administration of diacetyl midecamycin which evolved favorably following discontinuation of the drug. Despite its exceptional frequency and based on the wide therapeutic diffusion of this group of antibiotics, we believe this case to be of interest.

[Acute hepatitis due to ticlopidine. A report of 12 cases and review of the literature]. / Hepatitis aguda por ticlopidina. Presentación de 12 casos y revisión de la literatura.

OBJECTIVE: To analyze the characteristics of hepatotoxicity due to ticlopidine. PATIENTS AND METHODS: We describe all the case of hepatotoxicity attributed to ticlopidine and reported to the Register of drug associated hepatopathies. We also obtained data from MEDLINE and the Spanish Medical Index regarding cases reported during the period 1982 2001. RESULTS: We reported twelve cases of hepatopathy related to the use of ticlopidine. These made up 5% of all the cases notified to the Register. Eighty three percent of the patients were male, and of an average age of 68 years. Sixty six percent required hospital admission. The latent period varied between 2 and 13 weeks. The liver lesion was of cholestatic type in 75% of the cases, hepatocellular in 16.6% and mixed in 8.3%. Twenty five percent of the patients had received sub therapeutic doses. CONCLUSIONS: Ticlopidine is often related to hepatotoxicity. This seems to be due to an idiosyncratic mechanism and is mainly cholestatic. The use of lower dosage than that recommended means that the desired therapeutic effect is not attained but does not protect against the development of hepatotoxicity. Doctors who use this drug should be aware of this so as to establish the true risk benefit relation.

Informed consent. Evaluation of the information provided to patients before anaesthesia and surgery.

The procedure for obtaining informed consent is often poorly appreciated by patients. The aim of this paper is to evaluate the verbal information given as part of the informed consent process before anaesthesia and surgery. A total of 300 randomly chosen patients (141 male and 159 female) were asked their opinion between 1993 and 1995 at the University of Murcia Hospital (Murcia, Spain). One hundred and fifty of these patients received scheduled surgery and the other 150 received emergency surgery. In general, the patients were not happy with the information they had received concerning their pathology and treatment. Although they had signed the consent documents, the patients did not feel they had really understood the risks involved in the surgery they had undergone.

[Preoperative information and informed consent in surgically treated patients]. / Información preoperatoria y consentimiento informado en pacientes intervenidos quirúrgicamente.

OBJECTIVE: Providing information is an important part of the doctor-patient relationship. In hospital practice today, patients and/or their families are sometimes given seriously inadequate information. Our aim was to analyze the quality of information received by patients before anesthesia and surgery. PATIENTS AND METHODS: The opinion of 300 patients (141 men and 159 women) at Hospital Universitario "Virgen de la Arrixaca" (Murcia, Spain) was studied from 1993 to 1995. The sample was a stratified random one with sex and age as the classifying variables. Surgery was scheduled in 150 cases and emergency in 150. Mean age was 42.88 +/- 1.20 years (SD = 20.84; range 3-90 years). RESULTS: Patients were unfamiliar with risks of surgery and anesthesia in 19% and 18.3% of the cases, respectively. No information was received by 69.3% of patients regarding surgical risks and an even higher 75% of patients received no information on risks of anesthesia. In 3.6% of scheduled operations, neither patient nor family members were required to sign a consent from, though these cases involved patients under 18 years of age. For emergency surgery this percentage was 5.4%. Lack-of-information percentages are higher in operations requiring local or regional anesthesia. CONCLUSIONS: We must underline the poor quality of patient knowledge about medical procedures and the scarce information provided. Even fewer patients known about the risks of anesthesia. A patient's signing of an informed consent form does not correspond to real knowledge of the risks involved in the procedure.

[Use of EMLA cream and ropivacaine in dacryocystorhinostomy with locoregional anesthesia and sedation]. / Uso de crema EMLA y ropivacaína en la dacriocistorrinostomía con anestesia locorregional y sedación.

OBJECTIVE: To assess the usefulness of locoregional anesthesia and sedation as an alternative to general anesthesia for dacryocystorhinostomy. PATIENTS AND METHOD: Study of 20 patients undergoing dacryocystorhinostomy between April and October 1999. All the processes were carried out by the same surgeon under locoregional anesthesia plus sedation. We used EMLA cream to anesthetize nasal mucosa and ropivacaine for infiltration and anesthetic block; midazolam and fentanyl were used for sedation. RESULTS: Surgery was possible in all cases under locoregional anesthesia with no noteworthy complications. Anesthesia in the zone was good (assessed by hemodynamic changes and by asking the patient during and after the process). The experience was described as good by 70% of patients and poor by only 5%; the surgeon emphasized that bleeding was less than when the procedure is performed under general anesthesia. All patients were released within 24 hours. CONCLUSIONS: Using locoregional anesthesia and sedation for dacryocystorhinostomy is safe and effective and provides a valid alternative to general anesthesia. We suggest using EMLA cream in the nasal dressing and ropivacaine for infiltration. The process can be considered major outpatient surgery.

Upper limb functional assessment of children with cerebral palsy using a sorting box.

We investigated the use of a sorting box to obtain a quantitative assessment of upper limb motor function in children with cerebral palsy. In our study, children with and without cerebral palsy placed and removed geometrical objects of a sorting-box while their wrist position was monitored by a camera-based, motion-tracking system. We analyzed three different smoothness metrics (logarithmic dimensionless jerk, spectral arc-length and number of peaks) together with time to task completion. Our results suggest that smoothness metrics are an effective tool to distinguish between impaired and non-impaired subjects, as well as to quantify differences between the affected and less-affected sides in children with hemiparetic cerebral palsy.