A quality improvement intervention on surgical prophylaxis impact in antibiotic consumption and cost in selected surgical procedures.

BACKGROUND: Improper compliance with antibiotic prophylaxis (AP) in surgery is associated with an increased risk of surgical site infection (SSI), and impacts the efficiency of healthcare. OBJECTIVE: Evaluate the impact of an intervention in compliance with AP in selected surgical procedures and its effect on antibiotic consumption and cost. METHODS: A prospective interventional study was performed in a community hospital from January to December 2022. The baseline period was considered January-April 2022 and the intervention period May-December 2022. All patients who underwent cesarean section, appendectomies, hernia surgery, open reduction and internal fixation (ORIF), abdominoplasty, and cholecystectomy during the study period were selected. The intervention includes staff education, pharmacy interventions, monitoring the quality of prescriptions and feedback, and improved role of anesthesia staff, and department champions. RESULTS: The study involved 192 and 617 surgical procedures in the baseline and intervention periods respectively. The compliance with timing, selection, dose, and discontinuation achieved 100%, 99.2%, and 97.6% from baseline figures of 92.7%, 95.8%, and 81.3%, respectively. The antibiotic consumption was reduced by 55.1% during the intervention with a higher contribution of other antibiotics (94.1% reduction) in comparison with antibiotics as per policy (31.2% reduction). The cost was reduced by 47.2% (antibiotic as per policy 31.9%, other antibiotics 94.2%). CONCLUSION: The implemented strategy was effective in improving the quality of antibiotic prophylaxis with a significant impact in reducing antibiotic consumption and cost.

Early evolutionary differentiation of morphological variation in the mandible of South American caviomorph rodents (Rodentia, Caviomorpha).

Caviomorphs are a clade of South American rodents recorded at least since the early Oligocene (> 31.5 Ma) that exhibit ample eco-morphological variation. It has been proposed that phylogenetic structure is more important than ecological factors for understanding mandibular shape variation in this clade. This was interpreted as a result of the long-standing evolutionary history of caviomorphs and the early divergence of major lineages. In this work, we test this hypothesis through the analysis of morphological variation in the mandible of living and extinct species and compare this information with that obtained through comparative phylogenetic analyses. Our results support the hypothesis of early origin of mandibular variation; moreover, they suggest the conservation of early differentiated morphologies, which could indicate the existence of constrained evolutionary diversification.

Patterns of cranial shape diversification during the phylogenetic branching process of New World monkeys (Primates: Platyrrhini).

One of the central topics in evolutionary biology is understanding the processes responsible for phenotypic diversification related to ecological factors. New World monkeys are an excellent reference system to investigate processes of diversification at macroevolutionary scales. Here, we investigate the cranial shape diversification related to body size and ecology during the phylogenetic branching process of platyrrhines. To investigate this diversification, we used geometric morphometric techniques, a molecular phylogenetic tree, ecological data and phylogenetic comparative methods. Our statistical analyses demonstrated that the phylogenetic branching process is the most important dimension to understand cranial shape variation among extant platyrrhines and suggested that the main shape divergence among the four principal platyrrhine clades probably occurred during the initial branching process. The phylogenetic conservatism, which is the retention of ancestral traits over time within the four principal platyrrhine clades, could be the most important characteristic of platyrrhine cranial shape diversification. Different factors might have driven early shape divergence and posterior relative conservatism, including genetic drift, stabilizing selection, genetic constraints owing to pleiotropy, developmental or functional constraint, lack of genetic variation, among others. Understanding the processes driving the diversification among platyrrhines will probably require further palaeontological, phylogenetic and comparative studies.

Determination of the optimal rate for the microaerobic treatment of several H2S concentrations in biogas from sludge digesters.

The treatment of H2S in the biogas produced during anaerobic digestion has to be carried out to ensure the efficient long-lasting use of its energetic potential. The microaerobic removal of H2S was studied to determine the treatment capacity at low and high H2S concentrations in the biogas (0.33 and 3.38% v/v) and to determine the optimal O2 rate that achieved a concentration of H2S of 150 mg/Nm3 or lower. Research was performed in pilot-plant scale digesters of sewage sludge, with 200 L of working volume, in mesophilic conditions with a hydraulic retention time of 20 d. O2 was supplied at different rates to the headspace of the digester to create the microaerobic conditions. The treatment successfully removed H2S from the biogas with efficacies of 97% for the low concentration and 99% for the highest, in both cases achieving a concentration below 150 mg/Nm3. An optimal O2 rate of 6.4 NLO2/Nm3 of biogas when treating the biogas was found with 0.33% (v/v) of H2S and 118 NLO2/ Nm3 of biogas for the 3.38% (v/v) concentration. This relation may be employed to control the H2S content in the biogas while optimising the O2 supply.

Baseline description of the Spanish Academy of Dermatology infantile haemangioma nationwide prospective cohort. Comparison of patients treated with propranolol in routine clinical practice with previous pivotal clinical trial data. / Descripción basal de la cohorte prospectiva de hemangioma infantil a nivel nacional de la Asociación Española de Dermatología. Comparación de los pacientes tratados con propranolol en la práctica clínica rutinaria y los datos de un ensayo clínico pivotal previo.

BACKGROUND: There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity. METHODS: Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n=601). RESULTS: The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported. CONCLUSIONS: As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed.

Spatial regression techniques for inter-population data: studying the relationships between morphological and environmental variation.

Understanding the importance of environmental dimensions behind the morphological variation among populations has long been a central goal of evolutionary biology. The main objective of this study was to review the spatial regression techniques employed to test the association between morphological and environmental variables. In addition, we show empirically how spatial regression techniques can be used to test the association of cranial form variation among worldwide human populations with a set of ecological variables, taking into account the spatial autocorrelation in data. We suggest that spatial autocorrelation must be studied to explore the spatial structure underlying morphological variation and incorporated in regression models to provide more accurate statistical estimates of the relationships between morphological and ecological variables. Finally, we discuss the statistical properties of these techniques and the underlying reasons for using the spatial approach in population studies.

Oral rapamycin: an alternative in children with complicated vascular abnormalities. / Rapamicina oral: una alternativa en niños con anomalías vasculares complicadas.

OBJECTIVE: Sirolimus mTOR inhibitor represents a major advance in the treatment of patients with complicated vascular abnormalities. The objective of this study was to present our series of pediatric patients with vascular abnormalities treated with oral sirolimus, and to conduct a review of the relevant literature. MATERIAL AND METHODS: A retrospective analysis of patients with complicated vascular abnormalities treated with oral sirolimus in our healthcare facility from 2016 was carried out. Initial dosage was 0.8 mg/m2 every 12 hours, and therapeutic range was 5-15 ng/ml. All patients received trimethoprim-sulfamethoxazole prophylaxis. RESULTS: 6 children -3 boys and 3 girls- with a mean age of 9.5 years at treatment initiation were included. 3 of them had head and neck lymphatic malformation, 2 had lower limb venous malformation, and 1 had combined lymphatic-venous malformation at the thoracoabdominal level. They all had received multiple previous treatments without improvement. Following sirolimus initiation, 5 patients had clinical improvement (mean time: 3.6 months) and 4 had radiological improvement (mean time: 6.6 months). Mild and transitory adverse effects were noted in the 3 cases. Today, 5 patients remain under treatment. CONCLUSIONS: Oral sirolimus is an effective and safe treatment in patients with complicated vascular abnormalities. Our results support sirolimus use in lymphatic and venous malformations in which previous treatments have failed, with a good symptomatic and, to a lesser extent, radiological response.

OBJETIVOS: El uso del inhibidor mTOR sirolimus ha supuesto un avance en el tratamiento de pacientes con anomalías vasculares complicadas. El objetivo de este estudio es presentar nuestra serie de pacientes pediátricos con anomalías vasculares tratados con sirolimus oral y hacer una revisión de la literatura al respecto. MATERIAL Y METODOS: Se realizó un análisis retrospectivo de los pacientes con anomalías vasculares complicadas tratados con sirolimus oral en nuestro centro desde el año 2016. La dosis inicial utilizada fue de 0,8 mg/m2 cada 12 horas y el rango terapéutico de 5-15 ng/ml. Todos los pacientes recibieron profilaxis con trimetoprim-sulfametoxazol. RESULTADOS: Se incluyeron seis niños, tres varones y tres mujeres, con una edad media al inicio del tratamiento de 9,5 años. Tres presentaban una malformación linfática en cabeza y cuello, dos una malformación venosa en miembro inferior y la última una malformación combinada linfática-venosa a nivel toracoabdominal. Todos habían recibido múltiples tratamientos previos sin mejoría. Tras el inicio de sirolimus, cinco pacientes mejoraron clínicamente (tiempo medio 3,6 meses) y cuatro radiológicamente (tiempo medio 6,6 meses). Se registraron efectos adversos leves y transitorios en tres casos. Actualmente, cinco pacientes continúan con el tratamiento. CONCLUSIONES: El sirolimus oral es un tratamiento eficaz y seguro en pacientes con anomalías vasculares complicadas. Nuestros resultados apoyan su uso en malformaciones linfáticas y venosas en las que han fracasado otros tratamientos, presentando buenas respuestas sintomáticas y, en menor medida, radiológicas.

Hydrogen sulphide removal in the anaerobic digestion of sludge by micro-aerobic processes: pilot plant experience.

H(2)S removal from biogas produced in anaerobic digestion of sludge through the introduction of oxygen under micro-aerobic conditions is studied. Research was carried out in two pilot plant reactors (working volume, 200 L each) treating sludge from WWTP with HRT of 20 days. Mixing was provided via sludge or biogas recirculation. Introduction of very low oxygen flow (0.013-0.024 L/L(reactor) d) successfully removed H(2)S content in biogas with an efficiency above 99%. Reactor performance during micro-aerobic operation in terms of biogas production, methane yield and COD removal were not affected by the amount of oxygen supplied, remaining stable and similar to the anaerobic behaviour. Sludge recirculation ( approximately 50 L/h) and biogas recirculation ( approximately 3.5 L/min) as mixing methods were found not significant in H(2)S removal from biogas while biogas recirculation reduced by 10 times dissolved sulphide concentration compared to sludge recirculation.

[Variation of central corneal thickness in diabetic patients as detected by ultrasonic pachymetry]. / Variación del espesor corneal central en pacientes diabéticos mediante paquimetría ultrasónica.

OBJECTIVE: To prove the existence of a correlation between central corneal thickness and diabetes. METHODS: Ultrasound pachymetry measurements were made in 1,000 patients. The sample was divided into two groups of patients: 953 of them were non-diabetic patients, and 47 were diabetic patients. RESULTS: The average central corneal thickness in diabetic patients was 571.96 +/- 26.81 microns with a range between 514 and 626. The average central corneal thickness found in non-diabetic patients was 544.89 +/- 35.36 microns with range of 448 to 649. The increase in central corneal thickness found in diabetic patients compared to non-diabetic patients was statistically significant (p<0.001, Student "t" test). CONCLUSIONS: We found that diabetic patients had an increased central corneal thickness when compared with non-diabetic patients.

Rapamicina oral: una alternativa en niños con anomalías vasculares complicadas / Oral rapamycin: an alternative in children with complicated vascular abnormalities

Objetivos: El uso del inhibidor mTOR sirolimus ha supuesto unavance en el tratamiento de pacientes con anomalías vasculares complicadas. El objetivo de este estudio es presentar nuestra serie de pacientespediátricos con anomalías vasculares tratados con sirolimus oral y haceruna revisión de la literatura al respecto. Material y métodos: Se realizó un análisis retrospectivo de lospacientes con anomalías vasculares complicadas tratados con sirolimusoral en nuestro centro desde el año 2016. La dosis inicial utilizada fuede 0,8 mg/m2 cada 12 horas y el rango terapéutico de 5-15 ng/ml. Todos los pacientes recibieron profilaxis con trimetoprim-sulfametoxazol. Resultados: Se incluyeron seis niños, tres varones y tres mujeres, con una edad media al inicio del tratamiento de 9,5 años. Trespresentaban una malformación linfática en cabeza y cuello, dos unamalformación venosa en miembro inferior y la última una malformación combinada linfática-venosa a nivel toracoabdominal. Todos habíanrecibido múltiples tratamientos previos sin mejoría. Tras el inicio desirolimus, cinco pacientes mejoraron clínicamente (tiempo medio 3,6meses) y cuatro radiológicamente (tiempo medio 6,6 meses). Se registraron efectos adversos leves y transitorios en tres casos. Actualmente,cinco pacientes continúan con el tratamiento. Conclusiones: El sirolimus oral es un tratamiento eficaz y seguroen pacientes con anomalías vasculares complicadas. Nuestros resultadosapoyan su uso en malformaciones linfáticas y venosas en las que hanfracasado otros tratamientos, presentando buenas respuestas sintomáticasy, en menor medida, radiológicas.(AU)

Objective: Sirolimus mTOR inhibitor represents a major advancein the treatment of patients with complicated vascular abnormalities.The objective of this study was to present our series of pediatric patientswith vascular abnormalities treated with oral sirolimus, and to conducta review of the relevant literature. Materials and methods: A retrospective analysis of patients withcomplicated vascular abnormalities treated with oral sirolimus in ourhealthcare facility from 2016 was carried out. Initial dosage was 0.8 mg/m 2 every 12 hours, and therapeutic range was 5-15 ng/ml. All patientsreceived trimethoprim-sulfamethoxazole prophylaxis. Results: 6 children –3 boys and 3 girls– with a mean age of 9.5years at treatment initiation were included. 3 of them had head and necklymphatic malformation, 2 had lower limb venous malformation, and 1had combined lymphatic-venous malformation at the thoracoabdominal level. They all had received multiple previous treatments withoutimprovement. Following sirolimus initiation, 5 patients had clinicalimprovement (mean time: 3.6 months) and 4 had radiological improvement (mean time: 6.6 months). Mild and transitory adverse effects werenoted in the 3 cases. Today, 5 patients remain under treatment. Conclusions: Oral sirolimus is an effective and safe treatment inpatients with complicated vascular abnormalities. Our results supportsirolimus use in lymphatic and venous malformations in which previoustreatments have failed, with a good symptomatic and, to a lesser extent,radiological response.(AU)

Descripción basal de la cohorte nacional prospectiva de hemangiomas infantiles de la Academia Española de Dermatología y Venereología. Comparación de los pacientes tratados con propranolol en la práctica clínica rutinaria y los datos del ensayo clínico pivotal previo / Baseline Description of the Spanish Academy of Dermatology Infantile Haemangioma Nationwide Prospective Cohort. Comparison of Patients Treated with Propranolol in Routine Clinical Practice with Previous Pivotal Clinical Trial Data

Introducción Existen diversas opciones terapéuticas para los hemangiomas infantiles (HI). El propranolol se utiliza con base en un ensayo pivotal. Nuestro objetivo fue describir las características del HI en la práctica clínica, incluyendo las terapias utilizadas, así como comparar las características de los pacientes tratados con propranolol y las de los pacientes del ensayo, para valorar su validez externa. Métodos Se incluyó consecutivamente a los pacientes que acudieron a doce hospitales españoles desde junio de 2016 a octubre de 2019 (n=601). Resultados La edad media fue de 3,9 (DE:1,9) meses, con una ratio mujer-varón de 2:1. La mayoría de los HI fueron de tipo localizado (82%, 495), superficial (64%, 383) y ubicados en cara (25%, 157) y tronco (31%, 188). El tamaño mediano fue de 17 (RI: 10-30) x 12 (RI: 7-20) mm. Se encontraron complicaciones en 16 (3%) pacientes. Se inició tratamiento en el 52% (311) de los casos. La mayoría de los pacientes recibió timolol (76%, 237), reservándose propranolol para las complicaciones o los HI de alto riesgo. El compromiso estético fue el principal motivo de iniciar la terapia (64%, 199). Las diversas características de los pacientes y de los HI tratados con propranolol fueron similares a las del ensayo clínico pivotal, aunque 1/3 de los HI no alcanzó el diámetro mínimo para cumplir los criterios de inclusión, y no se comunicó información pronóstica importante. Conclusiones Dado que muchos pacientes reciben tratamiento debido al compromiso estético, existe una necesidad de conocer mejor los resultados estéticos de las terapias e incrementar la evidencia sobre el uso de timolol, que actualmente es la terapia más común. El propranolol está siendo utilizado en una población generalmente similar a la del ensayo; sin embargo, esta afirmación no puede confirmarse de manera definitiva (AU)

Background There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity. Methods Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n=601). Results The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported. Conclusions As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed (AU)

Descriptive epidemiology of head and neck squamous cell carcinoma in Puerto Ricans.

This study comprised 134 patients who had developed head and neck squamous carcinoma (HNSCC), and attended the cancer clinics of the Otolaryngology Department at the Isaac González Martínez Oncologic Hospital between August 1993 and November 1995. In-person interviews, and medical record review of the HNSCC patients provided data on demography, family history of cancer, history of a second primary cancer, history of environmental, tobacco and ethanol exposure, and current disease status. The average age at the time of diagnosis was 62.3 (range 18-94), and eighty percent of the subjects were male. Most (59%) of the patients had moderately differentiated tumors and 14% had a recurrence of the carcinoma. The most frequent primary site in males was the laryngeal area, and the oral cavity in females. Exposure to alcohol and smoking were identified as predisposing factors in 95% of the patients.

Effect of oxygen dosing point and mixing on the microaerobic removal of hydrogen sulphide in sludge digesters.

Limited oxygen supply to anaerobic sludge digesters to remove hydrogen sulphide from biogas was studied. Micro-oxygenation showed competitive performance to reduce considerably the additional equipment necessary to perform biogas desulphurization. Two pilot-plant digesters with an HRT of ∼ 20 d were micro-oxygenated at a rate of 0.25 NL per L of feed sludge with a removal efficiency higher than 98%. The way of mixing (sludge or biogas recirculation) and the point of oxygen supply (headspace or liquid phase) played an important role on hydrogen sulphide oxidation. While micro-oxygenation with sludge recirculation removed only hydrogen sulphide from the biogas, dissolved sulphide was removed if micro-oxygenation was performed with biogas recirculation. Dosage in the headspace resulted in a more stable operation. The result of the hydrogen sulphide oxidation was mostly elemental sulphur, partially accumulated in the headspace of the digester, where different sulphide-oxidising bacteria were found.

Performance evaluation of oxygen, air and nitrate for the microaerobic removal of hydrogen sulphide in biogas from sludge digestion.

The removal performance of hydrogen sulphide in severely polluted biogas produced during the anaerobic digestion of sludge was studied by employing pure oxygen, air and nitrate as oxidant reactives supplied to the biodigester. Research was performed in a 200-L digester with an hydraulic retention time (HRT) of ∼20 days under mesophilic conditions. The oxygen supply (0.25 N m³/m³ feed) to the bioreactor successfully reduced the hydrogen sulphide content from 15,811 mg/N m³ to less than 400 mg/N m³. The introduction of air (1.27 N m³/m³ feed) removed more than 99% of the hydrogen sulphide content, with a final concentration of ∼55 mg/N m³. COD removal, VS reduction and methane yield were not affected under microaerobic conditions; however, methane concentration in the biogas decreased when air was employed as a result of nitrogen dilution. The nitrate addition was not effective for hydrogen sulphide removal in the biogas.

Major viral diseases affecting fish aquaculture in Spain.

The number of viruses isolated from fish has grown in the last few years as a reflection of the increasing interest in fish diseases, particularly those occurring in aquaculture facilities. Of all the described viruses, only a few are considered to be of serious concern and economic importance; they are described in this review, drawing special attention to the four families of viruses (Birnaviridae, Rhabdoviridae, Iridoviridae and Reoviridae) that have been reported in Spanish aquaculture. Infectious pancreatic necrosis virus, a member of the first family, is the most spread virus with a prevalence of 39%. Viral diseases are untreatable and because effective and safe vaccines for fish are not yet commercially available, a great care needs to be exercised when moving fish or eggs from one site or country to another. Some fish health control regulations have been legislated in Europe and USA.