Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side.

Background: New era of cardiac surgery aims to provide an enhanced postoperative recovery through the implementation of every step of the process. Thus, perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass (CPB). Hematic Antegrade Repriming (HAR) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL. Once the safety of the procedure in terms of embolic release has been proven, the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery (ERACS) programs. Methods: Two retrospective and non-randomized cohorts of high-risk patients, with similar characteristics, were assessed with a propensity score matching model. The treatment group (HG) (n = 225) received the HAR. A historical cohort, exposed to conventional priming with 1350 mL of crystalloid confirmed the control group (CG) (n = 210). Results: Exposure to any transfusion was lower in treated (66.75% vs. 6.88%, p < 0.01). Prolonged mechanical ventilation (>10 h) (26.51% vs. 12.62%; p < 0.01) and extended ICU stay (>2 d) (47.47% vs. 31.19%; p < 0.01) were fewer for treated. HAR did not increase early morbidity and mortality. Related savings varied from 581 to 2741.94 $/patient, depending on if direct or global expenses were considered. Discussion: By reducing the gaseous and crystalloid emboli during CPB initiation, HAR seems to have a beneficial impact on recovery and reduces the overall transfusion until discharge, leading to significant cost savings per process. Due to the preliminary and retrospective nature of the research and its limitations, our findings should be validated by future prospective and randomized studies.

Preoperative triage to detect SARS-CoV-2 infection in surgical patients: lessons learned for resuming surgery.

PURPOSE: To define the impact of the COVID-19 outbreak on hospital surgical activity and assess the incidence of perioperative COVID-19 within two protocolized screening pathways for elective and non-elective surgery. METHODS: We conducted a prospective cohort study of adults undergoing surgery during the COVID-19 outbreak. The elective pathway included telephone surveys and a quantitative polymerase-chain-reaction test (RT-PCR) only for patients who were asymptomatic and at low risk of infection. Only patients with negative screening underwent surgery. In the non-elective pathway, preoperative screening was performed during the hospital admission. RESULTS: Among 835 patients considered for the elective pathway, 725 had negative RT-PCR results and underwent surgery. This reflects an 83% reduction in surgical activity from 2019. Moreover, 596 patients underwent non-elective surgery, representing a 28% reduction. Preoperatively, 39 patients (6.5%) tested positive for SARS-CoV-2 and underwent surgery through the non-elective pathway, vs. none in the elective pathway (p < 0.001). Postoperatively, 1.4% of elective surgery patients and 2.2% of non-elective surgery patients tested positive (p > 0.05). Mortality was higher in non-elective surgery (0.6% vs. 2.9%, p < 0.001) and in patients with COVID-19 (0% vs. 14%, p < 0.001). CONCLUSIONS: The low incidence of COVID-19 in elective surgeries during the outbreak demonstrates the importance and effectiveness of preoperative screening, combining surveys and RT-PCR.

Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial.

Particulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08-0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation.

Hematic Antegrade Repriming: A Reproducible Method to Decrease the Cardiopulmonary Bypass Insult.

The current practice of cardiopulmonary bypass (CPB) requires a preoperative priming of the circuit that is frequently performed with crystalloid solutions. Crystalloid priming avoids massive embolism but is unable to eliminate all microbubbles contained in the circuit. In addition, it causes a sudden hemodilution which is correlated with transfusion requirements and an increased risk of cognitive impairment. Several repriming techniques using autologous blood, collectively termed retrograde autologous priming (RAP), have been demonstrated to reduce the hemodilutional impact of CPB. However, the current heterogeneity in the practice of RAP limits its evidence and benefits. Here, we describe hematic antegrade repriming as an easy and reliable method that could be applied with any circuit in the market to decrease transfusion requirements, emboli, and inflammatory responses, reducing costs and the impact of CPB on postoperative recovery.

[HOSPITALS AS PROMOTERS OF SMOKELESS SPACES: STRATEGIES AIMED AT SMOKING CONTROL] / El hospital como centro promotor de espacios sin humo: estrategias dirigidas al control del tabaquismo.

The objective of this study was to describe the measures introduced at the Hospital Germans Trias i Pujol, Barcelona, aimed at achieving a smoke-free environment, and encouraging research, training, and clinical approaches with respect to smoking. The experience gained as a center attached to the Catalan Network of Smokeless Hospitals since 2002 shows that preventing and controlling smoking requires a specific agenda developed by a competent committee comprising workers from all hospital areas. Likewise, coordination with other centers in the network is essential as it permits the sharing of experiences. The involvement of hospital management is critical for the effective introduction of health protection and promotion strategies, both in workers and in users. The raising of awareness and the ongoing training of all health workers and coordination with other health care providers in the Health network are the main aspects that require strengthening in the future.

El objetivo de este trabajo fue describir las medidas llevadas a cabo en el Hospital Germans Trias i Pujol de Barcelona, destinadas a conseguir un entorno libre de humo, así como al desarrollo de actividades de investigación, formación y abordaje clínico en relación al tabaquismo. La experiencia como centro adherido a la Red Catalana de Hospitales Sin Humo desde 2002 nos revela que para la prevención y control del tabaquismo es necesaria una agenda específica desarrollada por un Comité competente, compuesto por trabajadores de diferentes estamentos y servicios del centro. Del mismo modo, consideramos fundamental la coordinación con otros centros de la Red que permita compartir experiencias, así como la implicación de la Dirección del Centro para la implementación efectiva de las estrategias de promoción y protección de la salud, tanto en los trabajadores como en los usuarios. La sensibilización y formación continuada de todo el personal sanitario y la coordinación con otros servicios proveedores de salud de la red sanitaria se perfilan como los principales puntos a reforzar en el futuro.

Incidence of contralateral neurosensitive changes and persistent postoperative pain 6 months after mastectomy: A prospective, observational investigation.

Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.

RF Energy Harvesting System Based on an Archimedean Spiral Antenna for Low-Power Sensor Applications.

This paper presents a radiofrequency (RF) energy harvesting system based on an ultrawideband Archimedean spiral antenna and a half-wave Cockcroft-Walton multiplier circuit. The antenna was proved to operate from 350 MHz to 16 GHz with an outstanding performance. With its use, radio spectrum measurements were carried out at the Telecommunication Engineering School (Universidad Politécnica de Madrid) to determine the power level of the ambient signals in two different scenarios: indoors and outdoors. Based on these measurements, a Cockcroft-Walton multiplier and a lumped element matching network are designed to operate at 800 MHz and 900 MHz frequency bands. To correct the frequency displacement in the circuit, a circuit model is presented that takes into account the different parasitic elements of the components and the PCB. With an input power of 0 dBm, the manufactured circuit shows a rectifying efficiency of 30%. Finally, a test is carried out with the full RF energy harvesting system to check its correct operation. Thus, the RF system is placed in front of a transmitting Vivaldi antenna at a distance of 50 cm. The storage capacitor has a charge of over 1.25 V, which is enough to run a temperature sensor placed as the load to be supplied. This demonstrates the validity of the RF energy harvesting system for low-power practical applications.

Supervivencia a 5 años postratamiento de cáncer de mama: experiencia institucional / Breast cancer survival after 5 years of treatment: Institutional experience

Resumen OBJETIVO: Determinar la supervivencia a 5 años (global y libre de enfermedad) y su relación con las variables: recurrencia, etapa clínica, tipo y grado histológicos, tamaño del tumor, invasión ganglionar axilar e inmunohistoquímica. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y retrospectivo efec-tuado en pacientes con cáncer de mama atendidas en 2010 en el Hospital Militar de la Mujer, Ciudad de México, confirmado por histopatología. La supervivencia global y libre de enfermedad a cinco años se estableció a partir del tiempo trascurrido desde el diagnóstico hasta la ocurrencia de un evento (recidiva, metástasis o muerte) o fecha del último contacto, con límite a diciembre de 2015. RESULTADOS: Se analizaron 197 expedientes pero se descartaron 78: por repetición de casos (49), por falta de información (21), y debido a recurrencias de años previos (8). Los límites de edad fueron 30 y 84 años, con media de 56.2 años. Los casos en etapa temprana (hasta EC IIA) representaron 40%, la supervivencia global fue de 81% a 5 años. En las pacientes con recurrencias las probabilidades de supervivencia fue-ron de 51%; las pacientes en etapas avanzadas tuvieron menores probabilidades de supervivir. No fue posible demostrar asociación estadísticamente significativa entre el tamaño del tumor, tipo y grado histológico, inmunohistoquímica e invasión ganglionar y la supervivencia. CONCLUSIONES: El estudio demuestra que las pacientes en etapas avanzadas tienen menores probabilidades de supervivir, por lo que es imperativo que se continúen esfuer-zos en promoción de la salud hasta conseguir que la detección sea en etapas curables.

Abstract OBJECTIVE: To determine 5-year survival (global and disease-free) and its relationship with variables: recurrence, clinical stage, histological type and grade, tumoral size, axillary lymph node invasion and immunohistochemistry. MATERIALS AND METHODS: Observational, descriptive and retrospective study carried out in patients with breast cancer attended in 2010 at the Hospital Militar de la Mujer, in Mexico City, confirmed by histopathology. The overall survival and disease-free to five years has been established from the time elapsed since the diagnosis until the occurrence of an event (recurrence, metastasis or death) or date of the last contact, with a limit of December 2015. RESULTS: 197 records were analysed; however 78 were discarded either: by repetition of cases (49), due to lack of information (21) and due to recurrences from previous years (8). The age range were 30 and 84 years, with an average of 56.2 years. The cases in early stage (CS IIA) was 40%, and overall survival 81% at 5 years. In the patients with recurrences the probabilities of survival were 51%; and the patients in advanced stages were less likely to survive. It was not possible demonstrate of statistically significant association between tumoral size, type and histological grade, immunohistochemistry and lymph node invasion and survival. CONCLUSIONS: The study shows that patients in the update stages have less likely to survive, so it is imperative that efforts continue in health promotion until getting the detection in curable stages.

Rationale and design of a multicentre, prospective, randomised, controlled clinical trial to evaluate the efficacy of the adipose graft transposition procedure in patients with a myocardial scar: the AGTP II trial.

INTRODUCTION: Cardiac adipose tissue is a source of progenitor cells with regenerative capacity. Studies in rodents demonstrated that the intramyocardial delivery of cells derived from this tissue improves cardiac function after myocardial infarction (MI). We developed a new reparative approach for damaged myocardium that integrates the regenerative properties of cardiac adipose tissue with tissue engineering. In the adipose graft transposition procedure (AGTP), we dissect a vascularised flap of autologous pericardial adipose tissue and position it over the myocardial scarred area. Following encouraging results in acute and chronic MI porcine models, we performed the clinical trial (NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic MI undergoing coronary artery bypass graft. The good safety profile and trends in efficacy warranted a larger trial. STUDY DESIGN: The AGTP II trial (NCT02798276) is an investigator initiated, prospective, randomised, controlled, multicentre study to assess the efficacy of the AGTP in 108 patients with non-revascularisable MI. Patients will be assigned to standard clinical practice or the AGTP. The primary endpoint is change in necrotic mass ratio by gadolinium enhancement at 91 and 365 days. Secondary endpoints include improvement in regional contractibility by MRI at 91 and 365 days; changes in functional MRI parameters (left ventricular ejection fraction, left and right ventricular geometric remodelling) at 91 and 365 days; levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or re-hospitalisation at 365 days; and cardiovascular death or re-hospitalisation at 365 days. ETHICS AND DISSEMINATION: The institutional review board approved the trial which will comply with the Declaration of Helsinki. All patients will provide informed consent. It may offer a novel, effective and technically simple technique for patients with no other therapeutic options. The results will be submitted to indexed medical journals and national and international meetings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02798276, pre-results.

[Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases]. / Factores pronósticos en las paradas cardiorrespiratorias intrahospitalarias. Revisión de 760 casos.

BACKGROUND AND OBJECTIVE: The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. PATIENTS AND METHOD: Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. RESULTS: Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. CONCLUSIONS: Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals.

The real-life value of ST2 monitoring during heart failure decompensation: impact on long-term readmission and mortality.

CONTEXT: Prognostic value of ST2 levels and dynamics has not been investigated in acute heart failure (AHF) using prospective real-life measurements. OBJECTIVE: The objective of this study is to investigate the prognostic value of ST2 in AHF. METHODS: ST2 levels were determined at admission (n = 182) and discharge (n = 85). Primary endpoint was the composite of all-cause death and HF rehospitalisation at one year. RESULTS: Discharge ST2 (HR 2.42 [95% CI 1.46-4], p = 0.001) and ΔST2 (HR 2.32 [95% CI 1.21-4.57], p = 0.01) but not admission ST2, remained independently prognostic for the primary endpoint after comprehensive multivariable adjustment. ST2 significantly improved prognosis stratification on top of clinical variables and NTproBNP. CONCLUSIONS: Routine clinical use of discharge ST2 and ST2 dynamics provide independent prognostic information.

Clinical characteristics and vital and functional prognosis of out-of-hospital cardiac arrest survivors admitted to five cardiac intensive care units.

INTRODUCTION AND OBJECTIVES: Survivors of out-of-hospital cardiac arrest constitute an increasing patient population in cardiac intensive care units. Our aim was to characterize these patients and determine their vital and functional prognosis in accordance with the latest evidence. METHODS: A multicenter, prospective register was constructed with information from patients admitted to 5 cardiac intensive care units from January 2010 through January 2012 with a diagnosis of resuscitated out-of-hospital cardiac arrest. The information included clinical status, cardiac arrest characteristics, in-hospital course, and vital and neurologic status at discharge and at 6 months. RESULTS: A total of 204 patients were included. In 64% of cases, a first shockable rhythm was identified. The time to return of spontaneous circulation was 29 (18) min. An etiologic diagnosis was made in 86% of patients; 44% were discharged with no neurologic sequelae; 40% died in the hospital. At 6 months, 79% of survivors at discharge were still alive and neurologically intact with minimal sequelae. Short resuscitation time, first recorded rhythm, pH on admission >7.1, absence of shock, and use of hypothermia were the independent variables associated with a good neurologic prognosis. CONCLUSIONS: Half the patients who recovered from out-of-hospital cardiac arrest had good neurologic prognosis at discharge, and 79% of survivors were alive and neurologically intact after 6 months of follow-up.

Leptospirosis: informe de 61 casos / Leptospirosis. Report of 61 cases

Se presentan los datos clínicos y serológicos de 61 casos de leptospirosis diagnosticados en un periodo de dos años en el Valle de México. El diagnóstico se estableció con cuadro clínico y determinación de anticuerpos contra leptospira y observación de la leptospira en orina. Las manifestaciones clínicas más comunes fueron fiebre (100 por ciento), artralgias y mialgias (84 por ciento), ictericia (43 por ciento), exantema, equimosis y petequias (6 por ciento) y en un caso meningitiss aséptica. Los serotipos más comunes fueron L. canicola (63 por ciento), L. ballum (21 por ciento), L. icterohemorrhagie (8 por ciento). No se encontró relación entre el cuadro clínico y el tipo de leptospira. La probable fuente de contagio fueron los animales domésticos y el ganado vacuno y porcino. Sólo en seis casos fue posible el seguimiento completo de los pacientes, que evolucionaron satisfactoriamente con penicilina. La leptospirosis es una infección que no es tan rara en nuestro medio y hay que tenerla presente en pacientes que cursen con fiebre prolongada y que tengan factores de riesgo para adquirir la enfermedad

Vigilancia de salmonella en productos derivados cárnicos: Cuba, 1985-1988 / Surveillance of Salmonella in meat products: Cuba, 1985-1988

Se presentan los resultados de 17 904 muestras de embutidos y ahumados, así como 7 209 muestras de productos cárnicos semielaborados sometidos a examen para la determinación de Salmonella. Se hace una valoración sanitaria de los resultados y se hacen consideraciones en relación con los factores que pueden haber incidido en los mayores aislamientos

Niveles de plomo en alimentos no enlatados / Lead levels in uncanned food

Se les realizó determinación de plomo, por espectrofotometría de absorción atómica, a 280 muestras de productos alimenticios, no enlatados, y se compararon con las normas de Límite Máximo de Residuos (LMR) establecidos por el CAME y el CODEX Alimentario. El 35,7 % de los alimentos estudiados no tienen establecidas estas normas; sin embargo los niveles de plomo encontrados en los productos analizados no parecen constituir un riesgo toxicológico para la salud del consumidor

Niveles de plomo en alimentos enlatados / Lead levels in canned food

Se determinaron los contenidos de plomo por espectrofotometría de absorción atómica en 17 productos alimenticios enlatados. Se calcularon las medias, desviaciones estándar y el percentil 90 en cada uno de los alimentos estudiados. Teniendo en cuenta los niveles de plomo encontrados, se dividieron los mismos en 3 grupos que permitieran una adecuada valoración de éstos al diseñar un programa de vigilancia de contaminantes químicos en alimentos